Request an Appointment
Welcome! We're excited that you've decided to take the first step towards improving your well-being and overall health. Our team at Selah Counseling Center  are here to help you achieve your goals.  Complete the application to request an appointment and start your journey towards your healing. Our office will contact you for a consultation and help you connect with a provider that best serves your need.
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Full Name *
Date of Birth *
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Phone Number *
Home Address *
Email *
Which service are you requesting? *
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What brings you into counseling? *
How will services be covered? *
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Insurance Carrier
Insurance Member ID
If you can't be reached, can we leave a voicemail? *
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