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Appointments, Referrals & Intake Form

Due to the high volume of requests, a Counseling Intake Form is required to make an appointment.
This form must be completed accurately and in its entirety by the identified patient.
Once received, the patient will be contacted within 48 hours.

Instructions:  Simply click the link below to complete the secure HIPAA complaint Intake form
Simply complete & e-sign




Feel free to also call the Intake/Referral Line at 857-424-3154

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