Appointment Request - New Client
Please complete the following to request an appointment or consultation.  If you are experiencing suicidal thoughts and have a plan to act on these thoughts, please call 911 or go to the closest ER.
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This form is distributed to counselors of Hargrove Counseling/Level UP Life.  The counselor with the soonest opening, or that specializes in the services you request will be in contact with you.    Please check agree to acknowledge this information.   *
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