True North Counseling | SimplePractice

Who would be receiving care?

My partner and me

Someone else

Your info

First name

Last name

Phone

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What name do you prefer to go by?

Administrative

What prompted you to reach out at this time?

There is no need to provide details, this simply helps us understand timing and context.

How did you come to hear about us?

We appreciate knowing what led you here.

Client Preferences

Availability that works best for you

We will do our best to accommodate when possible.

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Is there anything else you would like to share?

For example: what you'd like to focus on, insurance or payment questions, etc.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.