Guyton Counseling Services, LLC

Guyton Counseling Services, LLC Send Message

Who would be receiving care?

My partner and me

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Your info

First name

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Phone

Name you go by

Date of birth

State

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Reason for care

How can we best help you?

Restore Calm Improve Focus Increase Performance Create Joy Heal from Loss Cooperate with Others Recovery from Substance Misuse Repair after Trauma Other

What kind of care is being sought?

Individual Counseling Family Counseling Couples Counseling EMDR Therapy Sports Performance Counseling Single Session Therapy

What mental health concerns or treatment have occurred in the past?

In therapy/counseling now In therapy/counseling in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

Administrative

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Referral source

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Billing & Payment

Payment Transparency

We are a self-pay only practice that can offer you a superbill for possible reimbursement. Are you OK with this?

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Client Preferences

Preferred appointment times (Weekdays only, dependent upon preferred clinician availability)

Morning Afternoon Evening Weekend

Preferred clinician

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Preferred modality

Do you want to see us in our office (In-Person) or remotely (Telehealth)?

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, what stood out that might make us a good fit, etc.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.