Schedule Appointment

A diverse team of mental health experts empowering you to brave the challenges of life

Please use this secure form to request an initial appointment, and our Client Coordinators will contact you in 1-2 business days. We know this form asks for a lot of information. But, it helps us to be able to schedule you more quickly.

We look forward to working with you!

Contact Information

Your Name

Email address

Phone number

By providing my email and phone number, I am giving The Counseling Collective permission to email, call and/or text me regarding scheduling.

I understand my email and phone number will not be shared or sold.

Location (Downtown Lancaster, East Petersburg, or virtual)

Location

If you have a preference, please specify which location you'd prefer to be seen at (East Petersburg or Downtown Lancaster) or if you'd prefer an online appointment.

Client Information

Client Name (who appointment is for)

Date of Birth

In order to assign an appropriate therapist, we need to know the client's age. Also, having date of birth helps us to check insurance benefits.

Address

Our goal is to match you with a therapist who specializes in your area of concern. Please briefly describe what brings you to therapy.

If you had someone in mind, or were referred to someone specifically, please list the therapists you'd like to work with. While our therapists' availability fluctuates, we will take your preferences into consideration. We cannot guarantee evening appointments.

Please note: Couples and/or family counseling is a self pay service. You can read more about this on our website.

Name and DOB of the Insured, if different from the client name

Member Number/ Policy Number

Having your member number helps us to check your mental health benefits before calling you back. If you would be self pay, just write N/A

Picture of Insurance Card Insurance benefits can be confusing. The best way to be clear about your insurance benefits is for us to see the front and back of your card rather than just your member number. We accept most Blue Cross, Highmark, and Quest plans.

Add file

Please upload a file

Picture of Driver's License In order to verify insurance benefits, we may need to have your full name and address. Uploading your driver's license can help us with this information.

Add file

Please upload a file

How Did You Hear About Us?

Referral by family, friend, school, Doctor, or other provider

Please write below which provider referred you here

Psychology Today Website

You Are A Previous Client Of The Counseling Collective

Social Media : The Counseling Collective Facebook/Instagram/YouTube

Google Search

The Counseling Collective Website

Insurance Company Website

Other

Please write below who referred you here

Please tell us how you heard about us here.

This is only a request for an initial appointment and does not guarantee an appointment, nor does this establish a therapist-client relationship. We will review the information you have provided to determine if we have a therapist available who would be a good fit for you. Please allow 1-2 business days for a response.

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