Counseling Assessment Scheduler

Counseling Consultation Scheduling

Please complete the form to schedule your counseling sessions.
Referral Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
YesNo
Name of Insurance:
Policy Number:
Name of Medicaid:
DNC Number:
Please upload a copy of your insurance card.

Cancelof

You are invited to schedule your Free Counseling Assessment. This does not replace your Intake Appointnment, if scheduled, for entry into the program for services. Please note that this is a separate assessment with the Counseling Department.

The counseling assessment will take 1 hour and 30 minutes. This will be a Zoom appointment and your face must be in view of the screen at all times. Please be in a safe, stable, quiet location, and with the ability to speak freely about your situation. No shows and/or missed appointments will result in a delay of processing your enrollment into the program. If you have any questions, you can contact the office at 314.328.4348, Ext. 1.

Choose a date and time below. You will receive a zoom confirmation by email. The link for the Zoom will be sent to the email address you provided above. *
Should be Empty:

Counseling Consultation Scheduling