Adaptive New Client Form
Thank you for your interest in Adaptive Counseling and Case Management. Please complete the form below to start the registration process. 

If you are experiencing a mental health emergency, please call 988. If you are experiencing a medical emergency, please call 911.

*By completing this form, you agree to receive minimal emails and phone calls from Adaptive (related to scheduling). You may also call us at 231-715-8466. 
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Email *
Client Name (If you're a parent or guardian requesting an appointment for someone else, please provide your name too.) *
Client DOB *
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Phone Number *
Preferred Method of Communication (By selecting email or text, you are giving consent for Adaptive Counseling and Case Management staff to communicate with you by email or standard SMS messaging regarding various aspects of your medical care, which may include, but shall not be limited to, test results, appointments, and billing. You understand that email and standard SMS messaging are not confidential methods of communication and may be insecure. You  further understand that, because of this, there is a risk that email and standard SMS messaging regarding my medical care might be intercepted and read by a third party). Information submitted through this form is stored securely and confidentially.
Insurance Provider (We are not currently accepting any new Meridian clients and we do not accept UHC).
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Do you have a preference for which therapist you see, or would you like our first available therapist?
Please briefly tell us your reason for seeking therapy.
How did you hear about us? If you were referred by your physician's office, please share their name and office name.
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This form was created inside of Adaptive Counseling and Case Management.