School Based Counseling Referral

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Thank you for your interest in our Mental Health Counseling services. This form serves as your initial referral to initiate the intake process.

Once your referral has been reviewed, a counselor will be in contact with you to schedule an initial consultation. To ensure a smooth start to your counseling journey, you will be asked to complete the necessary paperwork through our secure client portal, Simple Practice, prior to your first session.

We look forward to welcoming you and supporting you on your path to well-being.

HIPAA

While we will bill your insurance provider directly for covered services, it's important to understand that you are ultimately responsible for any remaining balance. This may include deductibles, copayments, coinsurance, or services that are not covered by your insurance plan. We encourage you to contact your insurance provider to verify your coverage and understand your financial responsibility.
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