New Client Inquiry Form
Thank you for contacting us. We will respond to all inquiries with 24 - 48 hours even if we do not have current openings.

Please note that this is not a forum to obtain crisis services. If you or your loved one need emergent help, please call 911 or go to your nearest emergency room.

We understand that it takes courage to reach out. Our mission is to provide you with the best treatment to help you achieve your goals. Congratulations on taking a step towards a better life!

Currently, we are offering virtual counseling sessions with our secure HIPAA compliant video conferencing system. This system is user friendly and allows us to maintain face to face contact (without masks). Our therapists are trained to help you navigate any questions you may have. Our primary objective is to make these sessions productive and convenient for you.

Our practice is out-of-network with all insurance companies.  This means that you may receive reimbursement if you have out-of-network benefits.  We also accept HSA, FSA, and HRA cards. We have a list of questions on our website that you can ask your insurance company about your benefits:

We have a range of fees and session types. Therapists' fees are listed on their profile page on our website.

We are looking forward to serving you!

Sign in to Google to save your progress. Learn more
Email *
Name *
Please specify who you making this inquiry for *
Name of client (if not yourself)
Date of birth of client *
Street address *
City *
State *
Zip code
Phone number *
Pronouns (ex. She/Her/Hers)
Have you or any of your family members received services at CFCE in the past? If so, please let us know your therapist's name. *
How did you hear about CFCE? *
What issues and concerns are you wanting to address in psychotherapy at this time? *
Do you prefer in person or virtual sessions? (See for more information about virtual sessions.) *
Are you looking for a particular type of therapy or approach (e.g. CBT, ERP, EMDR, Play therapy)? It's okay to be unsure about this.
Please let us know if you have a specific preference for a therapist (e.g. a therapist in the LGBTQ+ community, a therapist of a certain age, gender, ethnic/racial background, etc.)
Do you have a specific therapist you would like to see? If so please select below. *
What is your availability for therapy sessions? Please note that having more times available makes it easier for us to accommodate you. *
Do you have any other questions? Is there anything else you want us to know? Please share here.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Center for Counseling and Education, LLC.