Appointment – GRAVES COUNSELING AND WELLBEING GROUP

Request An Appointment

Please complete the form below to request an appointment. All fields are required.

Client Name

Parent/Guardian Name

Client Birthdate

Phone Number

Do you accept texts?

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Insurance Provider

What prompted you to seek counseling services?

How long has this been a struggle for you?

Please list the specific therapist(s) you would like to work with. What appeals to you about this therapist(s)?