In order to participate in online counseling, read, sign, and email this form to nacounselingfoundation@gmail.com
New Clients:
Please fill out the following forms and email them to nacounselingfoundation@gmail.com no later than 24hrs prior to your appointment time.
For Couple Therapy:
If you are a new client requesting an appointment through our portal, please leave a phone number in which you may be contacted, indicate if you are seeking individual or couple counseling, and if you will be self-pay or if you have insurance along with the insurance carrier if applicable. You will find that area to do so on the submit request page in the ‘Message to Practice’ field.