Tuesday, 07 September 2010
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Marital Status:
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Have you had counseling in this area before?
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No
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Are you the only one who knows about this situation?
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No
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Do you already know what you want to do?
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No
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What is the situation?
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What solutions are already in place?
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What are your expectations?
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I need help in the following areas:
Family Counseling
Conflict Resolution
Stress Management
Crisis Management
Anxiety
Panic
Depression
Poor Self Image
Major Loss/Grief
Co-dependency
Marital Conflicts
Family Conflicts
Pre-marital Counseling
Abuse
Addiction
Spiritual Development
Career and Business
Other
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If other please explain:
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Although Impact does not accept insurance as payment, we do allow consideration for our clients with insurance coverage for mental wellness. Please be aware that most insurance companies do not provide extensive coverage for mental wellness for elective counseling or life management.
Are you covered by medical insurance?
Yes
No
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Explain your benefits:
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