Welcome to Living Water Counseling Center
Please fill out the form below. A counselor will contact you in the next 48 business hours with more information. 
Email *
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By checking "Yes", I consent to calls, SMS text messages, and emails from a Living Water Counseling Center staff member.  *
Disclaimer: HIPAA mandates that we encrypt our messaging to maintain confidentiality. Since this form isn't inherently encrypted, it is our policy and duty as a healthcare entity to not use forms/email/text when sharing confidential information. Please do not submit confidential information through this form.  *
Name (first and last) *
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Phone Number  *
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Is the person seeking services under the age of 19? *
Briefly share your reasons for seeking counseling. *
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How important is having spirituality included in your counseling? *
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Time of day preference? *
Required
How did you hear about Living Water Counseling? *
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