Appointments | CIFT Counseling

We are here to support you through this season. To schedule a teletherapy appointment please complete and submit the form below.

Our team will contact you via email Monday through Thursday between 9:00am and 4:00pm or Friday between 9:00am & 1:00pm to schedule an intake session:

Name(s): (required)

Phone Number: (required)

Email: (required)

Age(s):

County of Residence:

If other, what county do you live in?

Type of session:

If this appointment is for Couple's therapy, please provide the contact information (phone/email) for the additional party:

Best Day(s) - hold control key to select more than one option:

Best Time(s) - hold control key to select more than one option:

Preferred Location(s) - hold control key to select more than one option:

Preferred gender of therapist:

Do you have a preference in your therapist's licensing/training status?

Do you have a budget for weekly counseling session?

If yes, what are you able to afford weekly?

Additional Comments Regarding Fee:

Have you ever seen a therapist at CIFT? If yes, who did you see?
When was the last time you saw this therapist (year)?
Would you like to see the same therapist, if they are available?

Please share with us the nature of your main problem.

How serious does this problem feel to you?
Please rate 1-5 (5=most serious)

How did you hear about us?

If you were referred by a church, please share which one:

Please leave this field empty.