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Counseling

Counseling request form

If you would like to start counseling services with CAFA please fill out the following form.

This is not the form to complete to start groups. For domestic violence intervention, anger management, or parenting groups, use the group sign-up form instead.

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About you

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Please enter a valid email address.

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Services
What services are you interested in? (choose any)
Insurance

What health insurance would you like to use?

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What is the member ID # on your insurance card?

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What is the group # on your insurance card?

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Is there a phone number listed on the insurance card for providers? (Typically found on the back of most insurance cards.)

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Preferences
Provider Gender Preference
Would you be interested in working with an intern?
Click here to complete the Counseling New Client Paperwork