APCC Pre-Screen Form
This form will take about 10 minutes to complete.  If you need assistance, please contact us at (407) 536-8670

Step 1:  Complete this pre-screen form

Step 2:  Check your email for an approval or denial email within 24-48 business hours (9AM - 6PM, Monday - Thursday).  Approval is based on your responses.  If denied, a link with resources will be provided.

STEP 3:  After requesting an appointment, it will remain pending until all intake paperwork is submitted, reviewed, and—if you're a self-pay client—payment is received and cleared.

Please check your inbox and spam folder for your paperwork link from the Client Portal. Be sure to read all documents carefully.

Frequently Asked Questions

Who Do You Serve?
We serve women of color ages 30 and up navigating leadership, ministry, entrepreneurship, and other high-impact roles. Our services support emotional wellness, clarity, and sustainable growth.

What Services Are Offered?
Individual counseling, leadership and executive coaching, high-touch mentorship, group coaching and wellness experiences, mental health assessments and wellness planning, and corporate and community wellness consulting.

Form Completion Requirements

1. All required documents must be submitted within 72 hours of receipt.

2. Forms must be complete, signed, and accurate.

3. If using insurance or third-party payment, verification must be confirmed prior to approval.

4. Appointments remain unapproved until documentation and (if applicable) payment is cleared.

Do You Accept Insurance?
We only accept Cigna. All other clients are considered out-of-network and may request a superbill for potential reimbursement.

Out-of-Pocket Options
We accept private pay, all major credit cards, HSA/FSA, and approved third-party vouchers.
 View rates here.  

EAP Options
We currently accept CignaLifeWorks, ENI and Interface EAP, when pre-authorized by the employer.

Reduced Fee Option
Yes, we offer reduced-rate sessions through the Open Path Psychotherapy Collective.
APCC is not affiliated with Open Path and availability is limited.

Sliding Scale Option
No, we do not offer a traditional sliding scale.
We provide affordable access through The Healing Well™ Membership, a flexible, in-house program designed to support consistent care without relying on insurance or per-session billing.

Why Is a Credit Card Required?
A valid credit card must remain on file for the duration of care. It is securely stored in our HIPAA-compliant portal and only used for approved payments. Cards are deleted upon discharge and account closure.

If your card is declined, you will have 48 hours to update it. Unresolved payments may result in account closure.

Phone Consultations
We do not offer phone consultations. All scheduling decisions are based on your Pre-Screen Form submission.

What Happens at the First Appointment?
We will explore your presenting concerns, discuss your goals, and determine if we are a good fit to work together. We'll also outline next steps and answer any questions you may have about the process.

If You’re Not Ready to Pay
Please do not submit the form if you are not ready to pay our listed rates, use an approved EAP, or confirm active Cigna insurance coverage.

Waitlist
We do not maintain a waiting list.

Response Time
You will receive a response within 24–48 business hours. APCC administrative hours is open Monday through Wednesday, 8:30AM – 5PM EST.  

New Client Paperwork
Yes. If your Pre-Screen Form is approved, you will be sent intake paperwork. Appointments are not confirmed until all forms are reviewed and payment is processed (if applicable).

Timeframe to Complete Intake Paperwork
You have 72 hours from the time paperwork is sent to complete all required forms. If not completed within that window, your file will be closed.

Payment Before First Appointment
Self-pay clients are required to submit full payment for the intake session—$200 or the approved reduced rate—before the appointment can be approved.

Insurance users will be notified of any expected co-pays or cost-share details in advance.

Disclaimer: If you are experiencing a crisis or emergency, please call 911 or go to your nearest emergency room. This form is reviewed within 24–48 business hours and does not initiate services. For additional support, visit: 👉 www.authenticperspectivescc.com/resources

Email *
Today's Date *
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Have you read all the information above regarding services, policies, and rates?
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Are you completing this form for yourself?  (Clients must be 30 years or older to receive services at APCC) *
Age *
What services are you interested in?
Please note: APCC does not offer therapy for teens or children, or AODA counseling.
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Required
Briefly describe your main concerns or stressors.   Your response may impact the approval or denial of this Pre-Screen Form.   *
Why have you chosen this time to seek therapy or support?  Be specific but concise. Your response may impact the approval or denial of this Pre-Screen Form.   *
What would feel better or different in your life with progress toward your goals?  Be specific but concise. Your response may impact the approval or denial of this Pre-Screen Form.
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How motivated are you (or the person receiving services) to participate in therapy?  Scale of 1 (Not Motivated) to 5 (Motivated)  
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Have you previously participated in therapy? 
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What led you to Authentic Perspectives Counseling & Coaching (APCC)?
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How did you hear about Authentic Perspectives Counseling & Coaching?
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