Our online intake form contains four sections and requires approximately five minutes to complete.

We believe in the sanctity of your privacy and keep all information confidential.

If you have not scheduled your first appointment, our office will call you shortly afterwards to confirm individual availability.

Please remember to bring your health insurance card with you at your first appointment.

If you would prefer to request a recommendation before submitting your intake, our directors are glad to help.

 For your security and privacy, the information you submit will be sent in a secure encrypted transmission that protects your sensitive information.

Depending on your browser, you should see a padlock at the top of the address bar and a live McAfee security seal on the lower right of your screen.

Our Intake Form:

  1. Please provide at least one way for contacting you:

  2. Employment & Insurance Information
  3. (this information is often on the back of your insurance card)
  4. (if listed on insurance card)

  5. Personal & Medical Information
  6. (if applicable)

  7. Mental Health History
  8. Before submitting, please make sure you have provided us at least one way of contacting you. Press here to double-check the top of the form now. 

The Center for Counseling Arts

Where the quality of care matters & counseling is an art