Request an Intake Appointment

Angelus Therapeutic Services

Please correct the errors described below.

Client Information

Please list if contact person is not client, ie, parent or care taker
Please indicate how you would prefer for us to contact you. If you request to have your intake set up via email you will need to be sent and complete our credit card form prior to being able to confirm a scheduled appointment. We CANNOT schedule intakes via text messaging as it is not a secure form of communication. Emails will come as encrypted from admin@angelus.hush.com. If you are expecting a response via email please check your spam/junk folder as at times these can be funnelled there by your email provider.

Insurance & Payment

Please choose the insurance you would be using
Who carries the insurance plan that you use?
If your insurance is carried by anyone other than you, please list their first and last name, birthday, phone and address. This information is required by the insurance company as verification and not for us to reach out to that person.
Please list any secondary or tertiary insurance information you may have
    Please upload a file
    Insurance can be complicated. This chart may help you explore which therapists may be in and out of your insurance network.

    About Your Appointment

    Presently at capacity for Couple's counseling with no anticipated date of availability
      Please upload a file
      Please let us know any presenting issues, concerns, or areas you would like to work on in counseling so that we can match you with the best therapist to meet your needs.
      Please let us know how you found our office, were you referred by someone, see us on social media or find us through a google search? This will help us with coordinating your care
        Please upload a file

        Your information will be encrypted.

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