Your Journey of Growth with Valiant Minds Counseling!
"Begin your journey to a healthier, more joyful life with Valiant Minds Counseling. To get started, please complete the contact form with your details, and we will reach out via email with information on how to schedule your initial session or respond to any inquiries you have. Your journey towards healing and personal growth begins with this step."
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First Name:  *
Last Name: *
DOB (Date of Birth) *
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Relationship to person seeking services: *
Required
Phone number *
Email *
Preferred Method of Contact: *
What services are you looking for?  *
Required
Primary Insurance Company: *
Member ID for Insurance:  *
Group Number  *
Insurance subscriber Name: *
DOB of Insurance Subscriber: *
Secondary Insurance ID number (if any):
Secondary Insurance Subscriber Name and DOB:
Why are you seeking counseling services at Valiant Minds Counseling, and what goals do you hope to achieve? *
When would you like to start services?  *
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What days out of the week are you available for therapy or coaching sessions?   *
Required
Do you have a time preference on when therapy or coaching can occur?  *
Required
Do you have any flexibility in your schedule that could allow for daytime appointments if necessary?  *
How often would you prefer to attend therapy or coaching sessions?  *
Required
Do you have a preference for receiving therapy or coaching sessions in person or online?  *
Any additional information or questions you would like us to know? *
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