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Request a Counseling Appointment

Counseling Appointment Request Form

You may utilize this form to request a counseling appointment with a New Rhythms mental health counselor. You will then be contacted directly by an available counselor to schedule an appointment. You are also welcome to review our staff here, and contact a counselor directly.

While we do our very best to assign you to a counselor based on your needs, we are not always able to accommodate every scheduling or financial need. A counselor will reach out to you within 48-72 business hours after completing this request form.

Client First Name

Client Last Name

Clients Age

Client Birthday

Month

Day

Year

Guardian First and Last Name (if Applicable)

Client (or Guardian) Phone Number

Client (or Guardian) Email

How do you prefer to be contacted?

Phone

In 2-3 sentences, please explain your reason for pursuing counseling. Please specify if you are pursuing individual counseling or marriage counseling.

Accessibility/Fee Needs

Please note that NOT all counselors are able to bill insurance directly, and those that do have limited availability. For this reason, you will be asked to select two different financial preferences so that we can assign you to a counselor in a timely manner.

NRTC offers a wide-variety of payment options in an effort to remain as accessible as possible, to include helping clients receive reimbursements directly, sliding scale options, and accepting Care Credit. You can learn more about these here: https://www.newrhythmstherapy.com/fees-and-accesibility

Please select an option in each of the following dropdown question boxes below:

Please Select your first preference:

Please Select your second preference:

Private Insurance Plan (if applicable)

Scheduling Needs

Appointments are most commonly available on weekdays before 4pm. Some counseling staff offer sessions after 4pm on weekdays.

Earliest available (regardless of time)

I am available to schedule appointments with a counselor during the weekdays before 4pm

I would prefer a session after 4pm, and understand that only private pay counselors are available at these times.

Faith Integration Preferences

At NRTC, we recognize we serve a community with diverse spiritual needs. Please feel free to read more in our FAQ and to indicate a preference below.

Please select an option below:

No preference

I would like faith-neutral counseling

I would like a counselor trained in integrating the Christian-faith to my mental health care (when appropriate)

I would like counseling for religious trauma and spiritual abuse

Almost Done...

Please add any final preferences or requests here:

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