District Counseling New Client Intake Form
Thank you for your interest in therapy services from District Counseling LLC. Please complete this questionnaire in its entirety and once completed you will be contacted by a member of the D.C. team with details on next steps.
Please enter your full name.
Please enter Birthday
Please enter your primary phone number.
Please enter your insurance provider or indicate if you plan on being a cash pay client.
Ex. United HealthCare or Cash/ Out of pocket client
How did you find out about District Counseling LLC?
Send me a copy of my responses.
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