New Client Questionnaire

Monarch Counseling Service

Please correct the errors described below.

Client Information

We use this for our secure client portal, forms & billing.
Primary mailing address; also used for insurance billing.

Parent or Guardian Information

Insurance, payment and billing


Reasons for Visit

Once submitted, the information provided will be reviewed at our Weekly Team Meeting. As of Spring 2023, all therapists are at full capacity. We work to prioritize client needs with therapist availability, but the intake process can take from two weeks to two months. We will reach out to you after the initial review and follow up with the next steps.

Your information will be encrypted.