Your therapeutic journey starts here.
Thank you for your interest in our services. Be assured that the information collected below is private, secure, and protected under HIPAA.
Please complete all parts of this form so we can begin the intake, insurance verification, and scheduling process.
For child/adolescent services, parents/guardians should complete this form with the identified client being the child/adolescent.
For couples/family services: please choose one partner to be listed as the identified client.
At CPW, we’re committed to offering care that feels thoughtful, collaborative, and human. Completing this form helps us start our work together with care, intention, and a clear understanding of your needs.