Counseling Appointment Request

Please correct the errors described below.

We can only provide counseling to individuals in the State of Indiana, Florida, and South Carolina at this time.

Client Information

Times Available to Meet

About Your Appointment

Please be specific

Please attach a copy of your Drivers License or State ID.

If you are required to complete a specific type of counseling per court, probation, or another agency, please attach a copy of your paperwork.

    Please upload a file

    We will reach out to schedule a brief appointment with you to determine if Telemental Health counseling is a good match for your needs. Please note that our office is closed Saturday, Sunday and Monday, but we do have limited appointments on the weekend at times.

    Your information will be encrypted.