Matt Scheuneman- Client Request Form

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Email *

Your Name

Contact Phone Number (with area code) *

• Returning clients who have worked with him in the past.
• Pastors, physicians, executives, mental health therapists, and/or others who have restrictions on creating open/peer-based relationships because of their social roles.
• Individuals who are working through sexual addiction/compulsion.

Currently, Matt Scheuneman's practice with Haven has limited opening slots for him to take on working with new clients. However, he still desires to have some availability to connect with clients who have particular needs and who might find it difficult to find other counseling options. Areas of need where Matt works most to create session spaces for include: -Returning clients who have worked with him in the past.-Pastors, physicians, executives, mental health therapists, and/or others who have restrictions on creating open/peer-based relationships because of their social roles.- Individuals who are working through sexual addiction/compulsion. Which best describes your situation: *

I am a returning client who has worked with Matt in the past.

I am a pastor, physician, executive, mental health therapist, and/or otherwise am a person who has restrictions on creating open/peer-based relationships because of my social role(s).

I am someone who is working through sexual addiction/compulsion.

Other (please note that the option of "Other" cannot be responded to at this time)

If you have seen Matt for a session in the last 6 months, you do not need to complete this form. Instead, go to www.haven.clientsecure.me and follow the prompts to log in as an "existing client"

If you want to see a list of other providers at with Haven Counseling Center, please visit at providers.havencounselors.com

Matt currently does not have any additional scholarship-rated counseling slots available in his schedule. Matt's initial session rate is $197 (60 to 90 minutes), with all follow-up meetings at $147 per session (45 minutes). Matt is out-of-network with most insurance plans, but Haven can provide you with a superbill for you to submit to your insurance provider for them to reimburse you directly according to your out-of-network benefits. *

I Understand that counseling sessions are $197 (1st time) and $147 for all that follow

If you decide to submit a request here to work with Matt, please know that our ability to accommodate the request will still be subject to whatever limited opening's Matt has available in his schedule for new clients. We will only respond to requests that can be accommodated. *

I Understand that I will only be contacted if Matt has availability

Please note that if you selected the "other" option for reason for counseling, that Matt cannot make accommodations at this time and you will not be contacted *

I Understand that I will not be contact if my reason for counseling was "other"

Let us know briefly what you would like to address in counseling *

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