New Client Forms Available ONLINE!

WELCOME NEW CLIENTS!

It is truly an honor to know that you have chosen us to help in your journey for better mental and emotional health! 

Most intakes are done by phone at 302-376-0621 but we have decided to try something NEW! The following forms are ones that would be required for you to fill out upon your first visit.

To make the process a little less overwhelming YOU CAN BEGIN FILLING OUT FORMS NOW! This is in no way required to do in this manner we only offer it as an option to start your process that much sooner! We have edited the forms so that they work best for you. 

Since we cannot legally have you submit your information via Internet, we ask that you fax or email us the following forms.

First time clients who wish to request an appointment :
click here

Clients who have already spoken with a secretary and wish to complete patient information forms : click here

PLEASE fill out the below insurance form and bring it with you or fax it in. This not only saves time for you and the therapist, it ensures that you are covered for EXACTLY what you are requesting and that you are authorized to see a therapist: click here

For all MEDICAID and MEDICARE clients, please fill out this additional packet: click here

 

 

 

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Copyright © 2006 Middletown Counseling Services, Inc.
Last modified: 07/10/07  

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