Physician Referrals to Choices in Counseling

Referral Office Name

Referral Office Type

Referral Office Contact Name

Referral Office E-mail Address: *

Referral Office Phone:

Referral Office Fax Number:

What is the best way to contact the referral office?

Phone
E-mail
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Client Name: *

Client Address:

Client City:

Client State:

Client Zip:

Client Phone:

When is the best time to contact the client?

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Afternoon
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What is the client's primary insurance? *

Reason for referral:

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Find out more about Choices in Counseling and what we can do to help you and your family improve your view of the future. Continue to explore our web site by using the menu bar above or by clicking on any of the links below:

Stacks Image p2_n3 — Info about our staff, their hours and credentialing.
CLICK HERE

Stacks Image p2_n9 — Services we offer and information about therapy.
CLICK HERE

Stacks Image p2_n15 — Details on insurance reimbursement
and billing.
CLICK HERE

Stacks Image p2_n21 — Photos, contact info and maps to our office.
CLICK HERE

Stacks Image p2_n54 — Info about our staff, their hours and credentialing.
CLICK HERE

Stacks Image p2_n60 — Services we offer and information about therapy.
CLICK HERE

Stacks Image p2_n66 — Details on insurance reimbursement
and billing.
CLICK HERE

Stacks Image p2_n72 — Photos, contact info and maps to our office.
CLICK HERE

Call Choices in Counseling today at (317) 346-6252 with any questions you may have. We look forward to working with you.