Contact Us

General Questions

For New Clients

For Established Clients

Client Intake Form

Name of individual submitting request

First Name

Last Name

Name of client receiving counseling.

First Name

Last Name

Phone Number

Have you previously seen a counselor at Tree of Life Counseling?

Yes No

Select a session type

In person session Teletherapy session

Who are you seeking counseling for?

Age of client

How would you like to be contacted

Would you like to request a specific counselor?

What is Your Availability for appointments

Mornings (9AM - 12PM) Afternoon (12PM - 4PM) Evenings (4PM - 9PM)

Reason for seeking counseling.

Additional Information

HIPPA Compliance

By checking this box I consent to having my personal information collected for Tree of Life's support team to communicate. I understand that by checking this box, I am agreeing to receive emails which may contain information about my counseling services. If I do not wish to receive emails with this type of info, I understand I can complete my request over the phone at (850) 805-TREE (8733)