Sage Counseling and Wellness Potential Client Form
If you would like to schedule a free 15 minute consultation call with one of our therapists or are unsure of which clinician is the best for you, please complete the form below.

Please note that we are not in network with insurance. Consult this page for frequently asked questions. https://sagecounselingtherapyandwellness.com/therapist/ 

We look forward to speaking with you!
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Email *
Requested Services on (Today's Date) *
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First Name  *
Last Name *
Name of Client if a Child
Best phone number for you and/or the client we will be working with *
Are you a resident or attending school in the states of Georgia, South Carolina, Florida or Vermont? We can only work with individuals in the above mentioned states. *
Will one of our therapists be working with you, your child, or with you and a partner? If we will be working with your child, please confirm they are 16 or older. *
Do you prefer in person 
(Cumming, GA) or online sessions?
 *
Have you read our Frequently Asked Questions page? https://sagecounselingtherapyandwellness.com/therapist/ *
Select the therapist you would like to work with. *
Required
Will the topics you discuss align with our services? If you need a refresher of our services, use this link https://sagecounselingtherapyandwellness.com/therapyservices/ *
Please provide a brief description of what we will be discussing together. *
Is there a certain time of day that your require for a  session? *
Required
How did you hear about us? *
Do you acknowledge our video consultation call will be via Zoom call? *
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