top of page

Schedule an Appointment 

North Oakland Counseling

To arrange for an appointment please fill out the contact form below and send it. Make sure to include your email address and your phone number. We will make every effort to contact you promptly

(All information sent will be treated as confidential information and will not be shared with any third parties)

Note: If you are seeking marriage counseling please check with your health insurance prior to submitting this form as the majority of health insurances DO NOT cover marriage counseling.

CONTACT FORM

First Name

Last Name

Date of Birth (for health insurance validation)

Phone Number

May we leave you a message at this number?

Best time to reach you?

Email Address (a valid email address is required)

May we contact you by email?

What type of counseling are you requesting?

arrow&v

OTHER? please explain

Appointment Requested

arrow&v

Therapist Requested

arrow&v

Health Insurance Information so we can verify your benefits (If available) 1- Name of Insurance Plan 2- Id Number

Insurance Phone Number (found behind the insurance card)

Additional Information / Questions

 (Individual counseling, family counseling, couples and marriage counseling, counseling for children and adolescents, counseling for depression & anxiety, anger management, grief and trauma counseling, Rochester, Michigan) 

bottom of page