Guidepost Counseling for Wellness

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

State

Select the state you live in

Client Preferences

Preferred clinician

Select a clinician from the list

Billing & Payment

What is your plan for payment?

You can select more than one.

Insurance Cash pay Hoping for insurance but open to cash pay

If using insurance, who is your insurance provider?

Note: we are only in network with Partnership, some Blue Shield Plans, and Aetna.

What is the subscriber ID for your insurance?

may also be member ID. we do not need group number or other details.

How did you hear about us?

Reason for care

What are you looking for support with?

Limited to 600 characters

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice.