Karascope Counseling | SimplePractice

Karascope Counseling Send Message

Who would be receiving care?

My partner and me

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

State

Select the state you live in

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Reason for care

What kind of counseling are you seeking?

Individual Couples - Premarital Couples - Standard Couples Therapy (partners want to improve their relationship) Couples - Discernment (for mixed agenda couples, in which one person is leaning toward ending the relationship & the other person is leaning to repairing it) Other / Unknown

Please let us know if you have particular questions or a type of information that would be helpful to you as you determine your best fit with a therapist.

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Administrative

Referral source

Enter how you were referred to our services

Do you prefer to meet by video or in person?

PLEASE NOTE: Free consultations are typically done by phone, unless video is requested. Video calls are conducted through Karascope Counseling's secure client portal.

Phone (default for free consultations prior to beginning work together) Video (By request for 15-minute consultations and all other services.) In person (For those ready to begin services. Not an option for 15-minute consultations)

Billing & Payment

Please let us know if you have questions about Karascope's self-pay policy or status as non-insurance provider.

I have read and understood the information provided on provider's FAQs website page: https://www.karascopecounseling.com/fees-faqs I acknowledge my intention and ability to place a credit card on file in order to pay for services as they are provided. I understand the policy and still have questions.

Client Preferences

Is there anything you'd like your therapist to know before your first meeting?

For example: what you'd like to focus on, questions about style or treatment options, 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.