Carrie Roberts Counseling, LLC

Carrie Roberts Counseling, LLC Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Is the person in need of therapy 19 or older?

Carrie Roberts Counseling, LLC provides therapy services to adults age 19 and older.

Reason for care

What is the reason for seeking care?

Choose all that apply.

Life transition / stress Anxiety Depression Grief Relationship issues Substance use Trauma Other - space for comments below

Please tell me a little bit more about what’s bringing you to therapy at this time and what you’re hoping to get help with.

Limited to 600 characters

Administrative

Referral source

How did you hear about Carrie Roberts Counseling?

Billing & Payment

Payment method

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Client Preferences

Preferred appointment times

Morning Afternoon Flexible Availability varies

Preferred appointment type

Any additional questions or things you'd like me to know?

For example, scheduling requests, insurance/payment questions, general therapy questions, etc.

Limited to 600 characters

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.