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Spring Life Counseling Info Request Form
This form should take less than 5 minutes to complete.
The staff of Spring Life Counseling will do their best to hold any information shared with them in the strictest confidence. However, if there is information shared regarding the abuse or neglect of a child, older adult or person with disabilities, please be aware that as mandated reporters, our staff is required to file a report with the proper authorities within 24 hours.
All information submitted is encrypted, secure (SSL & this form feeds into a HIPAA compliant and encrypted version of G Suite). After you fill this form out, you will receive a response within two business day. (Note: If you are in crisis, please call 911)
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
I am interested in making an appointment for:
*
Myself (individual)
Me and my partner (couple)
Child
Family
Other:
I am looking for help with:
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My own mental health
My marriage
My engaged or dating relationship
My child or family
Other:
Required
Client Age(s)?
*
Your answer
Briefly tell us what is prompting your desire for counseling at this time.
*
Your answer
What appointment "windows" work best for you?
Please note:
-Not all counselors are available during all of these windows.
-Spring Life does not currently have availability to provide counseling for children / adolescents on weekends.
*
Weekday Morning (8:30 am - 11:00 am)
Weekday Midday (11:00 am - 2:00 pm)
Weekday Afternoon (2:00 pm - 5:00 pm)
Weekday Evenings (5:00 pm - 8:00 pm)
Weekends (Saturday or Sunday)
Which office location works best for you?
*
Woodstock (970 Woodstock Pkwy, Suite 210, Woodstock, GA 30188)
Tucker (5073 Lavista Rd, Tucker, GA 30084)
Telehealth Only
Please choose the best option.
*
I prefer a male therapist.
I prefer a female therapist.
I have no preference.
Do you already have an idea of which therapist you would like to work with?
More information about each of the counselors at Spring Life Counseling is available at this link:
Meet Our Team
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Courtney Putnam, Ph.D., LPC, (Woodstock, Telehealth)
Lana McNair, M.A., LPC, CIMHP (Tucker, Telehealth)
Jessica Richards, M,.A., LPC, LMFT, CPCS (Woodstock, Telehealth)
Ryan O'Kelly, M.Div., LPC (Woodstock, Telehealth)
Tim Gross, M.A., AMFT (Woodstock, Telehealth)
Jamie Goodwin, Master's Level Clinician (Woodstock, Telehealth)
Andrew McNair, M.Div., Pastoral Counselor (Tucker, Telehealth)
Judy Culpepper, Graduate Student Intern (Woodstock)
Ashton Webb, Graduate Student Intern (Woodstock)
I do not have a preference for a specific counselor and would like to speak with the Intake Coordinator to receive recommendations.
Do you attend a church in the metro-Atlanta area?
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Yes
No
If so, which church do you attend?
*
Your answer
Thank you for your inquiry.
Please note that the Spring Life Counseling is out of network for all insurance companies. However, we offer a range of services at different fees depending on the experience level of the therapist. We will contact you within two business days to follow up on your request.
Your answer
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