The Samaritan Counseling Center is committed to protecting you, our employees, and our community during the COVID-19 pandemic. We are seeing new and existing Clients through telehealth and phone communication.
The Samaritan Counseling Center is committed to protecting you, our employees, and our community during the COVID-19 pandemic. We are seeing new and existing Clients through telehealth and phone communication.

New Client Intake Form

Personal Information

* Required fields

Select Primary Phone Type *

Select Secondary Phone Type

 

 

 

 

EMPLOYER INFORMATION

EDUCATION

GROSS HOUSEHOLD INCOME

APPOINTMENT INFORMATION

Provide information on why you are coming to counseling so that we can best meet your needs *

 

professional counseling and care for the mind, body and spirit

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