Ready to get started?Start by filling out this form to get one step closer to your therapy journey. Legal Name * First Name Last Name Preferred Name/Prounouns If you have a preferred name that is NOT your legal name, please put it here. You are also able to put your preferred pronouns in this box. Email * Phone * (###) ### #### Do you need to inquire about reduced rate services? Yes, I need more information. No, not at this time. What's bringing you to therapy? * This is only reviewed by the therapist and the office administrator. If you would like to just let the therapist know directly, please put "N/A". I understand that Guardian Pack Counseling is not a Medicaid/Medicare provider and does NOT accept insurance. We are an out of network provider. We can provide you with a superbill as requested for potential reimbursement from your insurance. There is no guarantee your insurance will reimburse you. I understand and agree. I am 18 years or older or an assigned representative of the person coming in for counseling that is 18 years or older. * I agree. Are you interested in a 15 minute consultation with CJ before scheduling? * Yes - please contact me for setting this up. No - I would just like to schedule an appointment. Unsure - can you please provide more infromation? Thank you! Gabby or CJ will reach out to you within 24-48 business hours. If you have any questions prior to this, please don’t hesitate to email us at: info@guardianpackcounseling.com or call/text at 720-636-5704.Thanks,CJ If you are having trouble with the form or want to reach out directly please email us at: info@guardianpackcounseling.comOr call/text at: 720-636-5704
