Steps to Getting Started:

Fill out the new client contact form below.
Follow-up will occur within 24 hours Monday-Thursday.
A free 15-minute consultation phone call, will be scheduled.
During the call I will take time to discuss therapy and schedule your appointment.
Following our call I will send you paperwork through a secure portal to complete before your first appointment.

Please be aware that this form is not HIPAA-compliant, so avoid including any protected health information (PHI). I will follow up via a secure email.

Name

First Name

Last Name

Phone

(###)

###

####

Preferred Contact Method

Phone

Text

Are you seeking in-person or telehealth sessions?

In-person

Telehealth

Either is fine

What brings you to therapy at this time?

Have you seen a therapist before?

Yes

Is there anything else you'd like me to know before we connect?

How did you hear about Swank Counseling?

I understand this form is not for emergencies, and submitting it does not establish a therapeutic relationship.

I Understand

Steps to Getting Started:

Quinnett Swank, EdD

Swank Counseling and Wellness, LLC