Consultation Request Form

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Thank you for contacting Kim Lambert Counseling Services. Please complete the form below and allow us 24-48 hours to get back to you. The information you provide is confidential.

**** PLEASE NOTE: I am not accepting South Carolina or Virginia clients at this time ****

Date: *

YYYY

First Name: *

Last Name: *

Email: *

Phone: *

If you would like to receive a link to our portal with intake documents to start the process, please leave your date of birth :

Are you seeking in-person or virtual sessions?

In-person

Virtual

Both

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Preferred Method of Contact:

Phone

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Presenting Issue:

Referred by:

Insurance Provder:

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