Group services with Dandelion Family Counseling

Dandelion Family Counseling

newclient@dandelionfamilycounseling.com

**Please note, social skills groups are only offered at our Southpark location

Your first and last name

Your child's first and last name

How old is your child?

Please note we only provide group social skills for children ages 4-12.

Age 4: Waitlist full- please do not submit form at this time. Waitlist could open up soon, so please check back in.

Ages 5-7: Waitlist full- please do not submit form at this time. Waitlist could open up soon, so please check back in.

Ages 8-12: Waitlist availability and/or immediate availability

What is your email?

What is your phone number?

What state do you live in?

I acknowledge that Dandelion Family Counseling is a self-pay practice and DOES NOT ACCEPT INSURANCE. Full payment will be due at time of service. A super bill can be provided for potential out-of-network reimbursement.

What diagnoses (confirmed or suspected) or concerns are you hoping to address in counseling? Check all that apply or are suspected-**Please note our groups are specifically for children with a diagnosis of, or similar traits to, ADHD and Autism. If your child does not meet this criteria then this group will not be recommended

ADHD / ADD

Anger / Frustrations

Anger / Outbursts

Anxiety

Autism / Aspergers / Social Pragmatic Communication Disorder

Gifted

Pathological Demand Avoidance

Social Skills / Social Skills Group

Sensory Processing Disorder (SPD)

How did you hear about Dandelion Family Counseling?

I acknowledge that if there is a separation, divorce, custody agreement or co-parenting arrangement, that both parents are required to submit paperwork prior to the parent intake in order for my child to work with therapists at Dandelion Family Counseling.

Is there a separation, divorce, custody agreement, or co-parenting arrangement? (If yes, we require both parents to complete paperwork prior to the parent intake)

Yes

Thank you for your interest in our services. Due to the large number of new client inquiries, the following steps are a necessary part of our process.
1) Shortly after your online form is received, you will be sent an email from our Administrative Intake Assistant notifying you that we have received your request and that the next required step is completing paperwork through IntakeQ.

2) Complete IntakeQ paperwork. This is information regarding our policies and procedures and includes a detailed questionnaire about your child to learn more on whether or not group is a potential right fit for your child. This is a required step. Please note, if you do not complete this step within 7 days, you will no longer have access to the IntakeQ paperwork and will need to submit another online form to restart the process.

3) Once your paperwork has been reviewed, our Administrative Intake Assistant will contact you by email to let you know whether or not our group may be a potential fit for your child, and to explain next steps.

Your information will be encrypted.