Our online intake contains four sections & requires five to ten minutes to complete.
We believe in the sanctity of your privacy & keep all information confidential with HIPAA-compliant encryption.
If you have not scheduled your first appointment, our office will call you shortly afterwards to confirm individual availability.
The form below includes questions concerning your contact information, your health insurance provider (if applicable) and a brief personal history.
You will have the opportunity to submit your Health Insurance ID Card online through your smartphone, tablet or computer.
If you prefer, you may upload your card later through the ID Upload Portal accessible from the New Client Page found on the top navigation bar of our homepage. Or, you can bring your card to your first appointment.
If you would like to request a recommendation before submitting your intake, our director, Dr. Nancy Lardo, PhD, is glad to help.
For your security and privacy, the information you submit will be sent in a secure encrypted transmission that protects your sensitive information.
Depending on your browser, you should see a padlock at the top of the address bar and a live Trusted Site security seal on the lower right of your screen.
With the new day comes new strength and new thoughts.
- Eleanor Roosevelt
Our Online Intake Form:
The Center for Counseling Arts
Where the quality of care matters & counseling is an art