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This form is NOT meant for counseling emergencies, but rather to set up initial appointments and answer administrative questions that were not answered by browsing the website. If you are in an emergency, please contact 911 or 988 for assistance.

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I have reviewed the information under "Service Details" tab regarding superbills and am aware that Poplar Counseling & Wellness does not accept insurance. Please contact your insurance company for more information about how superbills may be applied to your deductible or be reimbursed.

I am aware that Poplar Counseling & Wellness PLLC does not accept insurance

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