Accepting New Clients for General Counseling, Dietitian Services, Interns, Marriage, Adult & Adolescent Anxiety IOP Groups

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Please fill out the following information to help us better assess which counselor is the best fit. After receiving your submission, someone will be in contact by the next business day to set up an appointment. If you have any trouble with this form call Renew at 913.768.6606 and press 0.

Location *

Olathe

Lawrence

Required

FYI about Insurance and Mental Health Service

The Anxiety Intensive Outpatient Programs for both Adults and Adolescents are covered by many insurance providers.

However, the majority of individual clinicians at Renew (and many other counseling centers) do not take insurance, but will create a "superbill" that you can submit and be reimburse by your insurance company. Click here to learn more about the benefits of not using your insurance for mental health services and how to utilize your Out-of-Network Benefits. https://renewkc.com/faq/

Seeking Group Therapy (not individual, couple or family) use these links
* Adult IOP: Request a Free Assessment: https://docs.google.com/forms/d/e/1FAIpQLSe4xdm7qMpTkwMjtNEgX8FcnSbRT_pmKOD0ilNVyOfSehc5MQ/viewform

* Adolescent (12-18) IOP for Anxiety/Depression: Request a Free Assessment: https://docs.google.com/forms/d/e/1FAIpQLScyEu4CCzcLChEveLDnEyAVYrb3SWEqO7kToI7NExLa_56EEA/viewform

Your Name *

Your relationship to the client: *

Self

Parent

Physician's Office

Spouse

Other:

Client's Name (if other than yourself)

Client's Age *

Desired Services:

Individual Counseling

Family Counseling

Couples Therapy

Dietitian Services

Adult Intensive Outpatient Program for Anxiety: https://goo.gl/forms/5ncy3O0yN8v6JwFm1

Adolescent (13-18) Intensive Outpatient Program for Anxiety: https://forms.gle/YkWvzor2Hpy5KLow6

Group Therapy

Equine Assisted Psychotherapy

Reduced Fee Student Intern (learn more at: https://renewkc.com/counseling/)

Other:

Best Contact Number? *

May we leave a voice message? *

Yes

E-mail Address

Preferred method of contact? (i.e. phone call, text, email) *

Payment Preference? *

Insurance

Private Pay

If insurance, what insurance provider?

If insurance, are you willing to use your out-of-network benefits to insure best therapist?

Yes

Clear selection

Are you interested in seeing one of our graduate intern counselors for a significantly reduced fee? Intern counselors are supervised weekly by seasoned therapists and provide excellent counseling at a reduced rate.

Yes

Clear selection

Who referred you?

Doctor

Therapist

Facility

Friend

Other:

May we contact the person who referred you to thank them?

Yes

Clear selection

Name of person who referred you:

Please describe the primary reasons you are seeking counseling support for yourself or someone else:

Is there anything else you think would be important for us to know?

Submit

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