Attachment Counselor
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  • Client Resources
  • Client Safety
  • Therapist Resources
  • On-Demand CEU Trainings Upcoming CEU Trainings
  • Into the Field Podcast Why Do People...?
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Attachment Counselor
  • Home/
  • New Clients/
  • Our Therapists/
    • Dr. Todd Frye
    • Dr. Taylor Johnson
    • Dr. Täna Arnold, LCPC
    • Maggie, Allen, M.A., LPC
    • Courtney Boyack, M.A., LPC
    • Jacob Bussmann, M. A., LPC
    • Hunter Cook ,M.A., LPC
    • Steve Dobisch, LPC, NCC
    • Seth Dunham, M.A., LPC, SATP
    • Will Eickman, M.A.,LPC
    • Landen Frye, M.A., LPC
    • Melissa Frye, M.A., LCPC
    • Chris Griese, M.A., LPC
    • Jonathan Melton, MA, LPC
    • Olivia Meyer, M.A., LPC
    • Kim Moss ,M.A., LPC
    • Kerri Myers ,M.A., LPC
    • Liz Nelson, M.A., LCPC
    • Daniel Rincones, MA, LPC, SATP
    • Jim Stites, M.A., LPC
    • Jessica Svoboda , M.A., P-LPC
    • Samantha Thomas ,M.A., LPC
    • Laura Weaver ,M.A., LPC
  • Client Resources/
  • Client Safety/
  • Therapist Resources/
  • Continuing Education/
    • On-Demand CEU Trainings
    • Upcoming CEU Trainings
  • Podcasts/
    • Into the Field Podcast
    • Why Do People...?
  • Sign InMy Account
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Attachment Counselor

AttachmentCounselor.com

New Clients

Attachment Counselor
  • Home/
  • New Clients/
  • Our Therapists/
    • Dr. Todd Frye
    • Dr. Taylor Johnson
    • Dr. Täna Arnold, LCPC
    • Maggie, Allen, M.A., LPC
    • Courtney Boyack, M.A., LPC
    • Jacob Bussmann, M. A., LPC
    • Hunter Cook ,M.A., LPC
    • Steve Dobisch, LPC, NCC
    • Seth Dunham, M.A., LPC, SATP
    • Will Eickman, M.A.,LPC
    • Landen Frye, M.A., LPC
    • Melissa Frye, M.A., LCPC
    • Chris Griese, M.A., LPC
    • Jonathan Melton, MA, LPC
    • Olivia Meyer, M.A., LPC
    • Kim Moss ,M.A., LPC
    • Kerri Myers ,M.A., LPC
    • Liz Nelson, M.A., LCPC
    • Daniel Rincones, MA, LPC, SATP
    • Jim Stites, M.A., LPC
    • Jessica Svoboda , M.A., P-LPC
    • Samantha Thomas ,M.A., LPC
    • Laura Weaver ,M.A., LPC
  • Client Resources/
  • Client Safety/
  • Therapist Resources/
  • Continuing Education/
    • On-Demand CEU Trainings
    • Upcoming CEU Trainings
  • Podcasts/
    • Into the Field Podcast
    • Why Do People...?
  • Sign InMy Account

NEW CLIENT INTAKE FORM

Please fill out the following information to set up a first time appointment with a counselor.  Should you change your mind at any point there is no obligation to attend counseling.  After receiving your submission, one of our counselors will contact you within 24 hours to talk you through the next steps and find out what might be a best fit for you.  All Information submitted will remain confidential. 

New Client Intake Form
Please fill out the following information to set up a first time appointment with a counselor. Should you change your mind at any point there is no obligation to attend counseling. After receiving your submission, one of our counselors will contact you within 24 hours to talk you through the next steps and find out what might be a best fit for you. All information submitted will remain CONFIDENTIAL.
Client Information
Name *
Gender
Birth Date
Phone
Address
Reference
Who Referred You?
May We Thank Them?
Presenting Concern
Presenting Symptoms *
What Type of Service
Preferred Counselor *
In Person or Telehealth *
Would you like to attend your appointments in-person or through telehealth?
Contact Information
Phone

Thank you for submitting your form.  We will look at your submission to determine the best counselor for you. Someone from freetoattach will be in contact with you based on your preferred method of contact. . 

 
 
 
 
 

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