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Intake Email For New Clients
ENTER YOUR CP EMAIL, NOT THE CLIENTS!!! This form puts together nearly everything to then email to the client for them to have access to everything but your PDS. Please make sure to include your PDS as an attachment for this email to the client.
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Email
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Your email
Date and Time of Intake Session From Step 1
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Your answer
How you would like your name to appear
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Your answer
Which Office will be your main Counseling Professionals PLLC Office
7406 Chapel Hill Rd Ste J, Raleigh, NC 27607-5039 (We are the townhouse on the left, near the end, upstairs)
808 Salem Woods Dr Ste 104 (June 1st, 911 Paverstone Dr), Raleigh, NC 27615-3345 (We are the office on the left when you come in the front door)
302 Jefferson St, Raleigh, NC 27603-1242 (We are Ste 180 around back)
18 West Colony Pl Ste 120, Durham, NC 27705-5582 (We are around the back of the building, downstairs, on the right)
Ext. 18 West Colony Pl Ste 180, Durham, NC 27705-5582 (We are around the back of the building, downstairs, on the right)
7330 Chapel Hill Rd Ste 203, Raleigh, NC 27607 (We are the white building on right, upstairs, down on the left near end of hall)
Telehealth (how to connect will be provided in more detail)
Other:
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What is your out of network rate (OON) Average is 100
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$100.00
$120.00
$140.00
$160.00
$180.00
$200.00
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