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CP Internal Referral Form
This form is for when clients need resources beyond a current Counseling Professionals PLLC means or ethical obligations and is seeking to find another Counseling Professionals PLLC Provider to fill that need. If you are looking for a specific specialty, location, insurance, or times, Please check out the following resources:
List of Provider specialties in detail:
https://docs.google.com/spreadsheets/d/17_JecOyqGBsJYAw0wSkqqleFT4cFw6o-QIxQMkfOo9E/edit?usp=sharing
Web link to Therapist on Website:
http://counselingprofessionalspllc.com/therapists.html
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Referring Provider Email
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Client Age
Your answer
Gender and Gender Identity
Your answer
Presenting Problem
Your answer
Insurance
Your answer
Available Times
Your answer
CP Location Interest
Cary
North Raleigh
Downtown Raleigh
Durham
Telehealth
Form Development
This form is in development. If there are other factors you would like included in this form, please let CJ know:
CJLeach@CounselingProfessionalsPLLC.com
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