NEW CLIENT INTAKE FORM

All new clients, please complete the information below.  Someone will contact you for scheduling.  Thank you

(For child/adolescent clients only)
(For child/adolescent clients only)
(For child/adolescent clients only)
(For child/adolescent clients only)

GENERAL CONTACT

This is for general communication- i.e. rescheduling appointments, question for your provider are just a couple examples.  Please specify the name of the provider if you wish the message to be forwarded.  We also have a phone number for both locations 724 884-0466 which is password protected if you wish to call us and leave a message.

Bridgeville office building

“You cannot solve a problem from the same consciousness that created it. You must learn to see the world anew.”

– Albert Einstein