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Timber Creek Counseling Intake Form
Timber Creek Counseling Intake Form
Hello, please fill out and submit this form to be added to our intake list. This form takes approximately 1-2 minutes to complete.  Do not use this form in case of emergency or if you or your child are feeling suicidal. Instead, please call 911, go to your nearest emergency room, or contact the national suicide hotline at 800-273-TALK (8255).
Intake Form
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    You can request this appointment for yourself, on behalf of someone else, or for both you and your partner. Please choose below.
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    Pick a Date
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    Please select all applicable concerns.
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    Please indicate all possibilities. The wait time is longer for evening hours.
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    Please also note here if you have a strong preference for a specific counselor and would like to be considered only for their waitlist. This could affect wait time.
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