New Clients

At Behind The Veil Consultations, PLLC, we are dedicated to providing a compassionate and supportive environment for your healing journey. Our team of experienced therapists is here to help you navigate life’s challenges with faith-based counseling tailored to your unique needs. We look forward to partnering with you on your path to wellness and growth.

New Client Form

Today's Date

First Name

Last Name

Email Address

Phone

Street Address

City, State, Zip

Insurance Company

Insurance Customer Service Number

Insurance Subscriber's Name

Subscriber Date of Birth

Subscriber Policy #

Group #

Subscriber SSN

Subscriber Employer

Client's Relationship to Subscriber

Client's Date of Birth

Desired Appointment Day (If Any) Desired Appointment Day (If Any) Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Desired Appointment Time

Desired Counselor Name (Optional)

Desired Location(s)

Desired Appointment Time

Brief Explanation for Seeking Counseling

Message

How did you hear about Behind the Veil Consultations, PLLC?

3 + 2 =

Get Started Today With Behind the Veil Consultations

Schedule a Free 15-Minute Appointment

By submitting this form, you are consenting to receive marketing communications from BTV Consultations PLLC. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact.