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About Us
- Our Story
- Fees & Insurance
Our Specialities
Our Team
Contact Us
Resources
- Our Blog
- Podcast
Hiring

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About Us
- Our Story
- Fees & Insurance
Our Specialities
Our Team
Contact Us
Resources
- Our Blog
- Podcast
Hiring

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Name *

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Best Number To Reach You *

Email *

How would you like to be contacted? *

Text
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What type of counseling do you need? *

Counseling for my child
Couples counseling
Family Counseling
Counseling for myself

If you are not certain, please list what you feel would be the most important primary service to start with. The intake coordinator will support you during the scheduling process.

Have you ever been seen by Santos Counseling? *

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Please specify the client's age range. *

Do you prefer In-Person or Virtual? *

In-Person
Virtual

Please share what brings you to therapy. *

Anxiety
OCD
Depression
Life Transition
Relationship/Marriage
Parent and Child Difficulties
Trauma
ADD/ADHD
Grief and Loss
School/Educational Challenges
LGBTQIA+
Multicultural Issues
Stress

Please check multiple age boxes if needed. Please only add information you are comfortable sharing. This is not a HIPAA compliant form. The completion of the form does not establish a counselor and client relationship. If you're experiencing a crisis that can't wait, please first contact 911 or go directly to your nearest emergency department.

What insurance plan are you on? *

Anything else you would like for us to know? *

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