Schedule Your Appointment Below

Please note that you are responsible for any copay you may have with your insurance, and all bariatric patients are responsible for the $125 report fee, which is not covered by insurance.

Name *
Name
Phone *
Phone
Preferred Date From: *
Preferred Date From:
Preferred Date To: *
Preferred Date To:
Preferred Time From: *
Preferred Time From:
Preferred Time To: *
Preferred Time To:

Please note: Filling out this form is not a confirmation of your appointment, nor is it a guarantee of an appointment. Appointments may vary depending on our therapists schedules, current caseload and the insurances they take. This form simply allows for us to determine who to schedule you with and when. A representative from The Counseling Center for Change will be in touch to finalize your appointment.

The Counseling Center for Change maintains a strict 24 hour cancellation policy. Should you determine that you cannot make your scheduled appointment, please call at least 24 hours prior to you appointment. Any appointments cancelled within the 24 hour window will be charged a $6o cancellation fee.