NEIGHBORS COUNSELING

Schedule Your Free 15-Minute Consultation Today!

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Begin Your Journey

New Client Intake

Thank you for considering Neighbors Counseling Services. To help us better understand your circumstances and match you with the most suitable option, please take a few moments to complete our intake form.

Upon submission, you'll be scheduled for a free 15-minute phone consultation with one of our therapy care coordinators. This consultation will help us discuss your needs and answer any questions you may have about therapists or provider availability, insurance information, or private pay rates.

We look forward to supporting you on your journey to improved mental health and well-being.

Schedule an appointment

September 2025

Week starting Sunday, September 14

Time zone: Coordinated Universal Time (UTC)Phone call

Tuesday, Sep 16

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM

Who is this intake for?

First name

Last name

Phone number

Birthday

Month

Day

Year

Address

Country/Region

Address

City

Zip / Postal code

Payment Preference

Types of Therapy Needed

Individual Therapy

Couples or Family Therapy

Psychiatric Evaluation Medication Management

Spravato Ketamine Assistant Psychotherapy

Support Groups and Workshops

Individual Therapy is our primary service and must be selected. Please select any additional service if you or a loved one are in need of these types of treatment.

How did you hear about our center?

I understand that this intake document is the first step in the treatment process. Please choose a convenient time for a free 15-minute therapeutic care consultation to match me with the best treatment option.