Renewed Wellness Counseling, PLLC

Renewed Wellness Counseling, PLLC Send Message

Your info

First name

Last name

Phone

Date of birth

Reason for care

What is the reason for seeking care?

Check as many or as little as you'd like. This helps us match you with the right therapist!

Anxiety & Worry Depression & Low Mood Relationship issues Trauma Life Changes Feeling overwhelmed or burned out Pregnancy or Postpartum Divorce, Custody, or Co-Parenting Military, first responder, or caregiver stress Chronic Illness or Medical Stress I’m not sure—I just know I’m not feeling like myself Other - See Below

What kind of care is being sought?

Individual Therapy (in person or virtual) Couples Therapy (only offered virtually at this time)

Administrative

What can we help you with?

Preferred Contact Method?

Phone Text Email

How would you like to meet?

This helps us determine what therapists to recommend.

Virtual In-Person No preference

Do you have a gender preference for your therapist?

Female Male No preference

Billing & Payment

If using insurance, who is your provider?

Please note: Our Medicaid (including Healthy Blue) and Medicare providers are currently full. We are not in network with Medicare Advantage plans.

If you'd like us to check your benefits before we reach out, please provide your Member ID #.

Not mandatory, but can reduce back and forth regarding insurance.

Client Preferences

Preferred appointment times

Morning (8am-12pm) Afternoon (12pm-5pm) Evening (5pm-8pm) Flexible

Message

Please let us know if you have any specific questions or a certain therapist you'd like to work with. If you have an insurance related question, feel free to provide your Insurance info and we'll check that before reaching out to you!

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.