New Patient

If you haven’t contacted us before, kindly take a moment to complete our new patient interest form located below on this page. We look forward to building a relationship with you.

Please Observe
Download Forms

If you are a parent, enrolling your child for a new patient intake, please observe the following: If the child's parents are no longer together, have never been together, or if the legal parents separating, or divorced, Cedars Counseling requires the signature of both parents before scheduling any intake appointments. Please download our policies for your review, and complete and return the consent form.  Please note: This form must be completed, signed, and initialed by both parents. Once you have filled out the forms, please send them to intakeforms@cedarscounseling.com. Upon receipt of the signed documents, we will proceed with scheduling your intake appointment, subject to availability at that time.

New Patients

Please us the new patient interest form below to get started. If you have questions, please give us a call.
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New Patient Interest Form

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Name
Birth Date
Address

Help us get to know you.

Are you seeking therapy for yourself or someone else?
Marital Status
Preferred Method of Contact
Have you received therapy or counseling before?
Are you currently experiencing any crisis or urgent situation that requires immediate attention?
Would you like to be contacted by our team to pair you with a therapist who could be a great fit (free of charge)?
Do you have any preferences for the therapist's gender, age, or specific qualifications?
Are you interested in in-person sessions, online therapy, or both?
Do you have any scheduling preferences or restrictions?
How did you hear about our therapy counseling services?
Will you use health insurance or self pay?
1. Adult Use Only: Choose all that apply.
2. Adult Use Only: Choose all that apply.
3. Adult Use Only: Choose all that apply.
5. Adult Use Only: Choose all that apply.
I am experiencing something else:
Preferred Appointment Days:
Please check all that apply.
Preferred Appointment Times:
Please check all that apply.
Healthcare Provider
I would like to provide more information:
Age Verification
I certify than I am over 18 years of age.

What is 7+4?

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