Joy Unlimited Counseling Center

Joy Unlimited Counseling Center Send Message

Who would be receiving care?

My partner and me

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

Sex at birth

For insurance verification

State

Select the state you live in

Billing & Payment

Insurance card upload

Upload a photo of your insurance card

Client Preferences

Preferred clinician

Select a clinician from the list

No results found.

Reason for care

What type of services are you seeking?

(select all that apply)

Individual Adult Counseling Individual Child Counseling Couples Counseling Family Counseling Spiritual Care Unsure

Do you prefer In-Person or Telehealth?

What is the reason for seeking care?

(select all that apply)

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Spiritual Issues Substance use Trauma Other

Is there anything that the therapist needs to know before starting your services?

For example: what you'd like to focus on, accommodations you need, etc.

Limited to 600 characters

Payment method

How do you plan to pay?

Payment details

Please list your insurance plan provider with your member ID and Group number. Any questions concerning your insurance coverage, please contact your insurance company member services number.

Limited to 600 characters

How were you referred to our services?

(select all that apply)

Church / Pastor Client (Existing / Former) Doctor / Healthcare Provider Employer Friend / Family Google search Legal System / Attorney School Social Media: Facebook, Instagram, LinkedIn, etc. Website: Joy Unlimited Counseling Center Website: Psychology Today Website: Other Other

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.