Appointments 3 — Center Soul Counseling

So, you’re ready to start the process.

Schedule a consultation.

Tell me a little about yourself, your child, or your family.

Please use the following form to share what you are seeking in therapy. Feel free to add what you feel comfortable sharing at this time; but please know most of the information gathering will take place during the consultation.

*This is not an encrypted form, so full confidentiality cannot be guaranteed; however, no other parties are privy to the information you provide.

katecluff@centersoulcounseling.com
406-546-9544

738 kensington avenue
missoula, mt 59801

*most insurance accepted

name & preferred pronouns

please feel free to only add what you feel comfortable sharing at this time.

what would you like me to know?

briefly share what you are seeking in counseling. remember, there will be lots of time to describe in detail what's going on for you during the consultation.

phone number

requested date & time

while there is flexibility in scheduling, initial consults are available M-F (exceptions may apply)

YYYY

time

Hour

Minute

Second

I am seeking:

CCPT (child centered play therapy)

EMDR (eye movement desensitization and reprocessing)

perinatal mental health

other

insurance

if you are seeking services that can be billed through insurance, please list what insurance provider you use. different providers have varying requirements.