Collaborative Counseling Group | Charlotte Area Counseling
  • Home
  • Who We Are
    • Staff >
      • Buffy Wimmer
      • Charles Wimmer
      • Gracia Blees
  • Services
    • Individual Counseling
    • Couples Counseling
    • Trauma Therapy
  • Client Forms
  • Contact
  • Donate
  • Year-end Letter

Client Intake Form


You have just taken a very positive step by deciding to seek counseling.  We are happy that you have chosen Collaborative Counseling Group.  Please take a moment to fill out some information about yourself.

The Intake form & Disclosure Forms may be downloaded here.  Please print form, fill it out and bring to your first appointment.

ccg_intake_form.pdf
File Size: 2705 kb
File Type: pdf
Download File

c2g_disclosure_and_client_s_informed_consent.pdf
File Size: 2690 kb
File Type: pdf
Download File

**For a couple’s intake session, please fill out two individual intake forms. 

** Parents and Guardians, please fill out the Additional Counseling Information form for your child or adolescent who is seeking counseling.

Payment Information

We are not currently paneled with any insurance company. We will assist you with out-of-network reimbursements by providing the  required paperwork for you to submit to your insurance company. Payment is expected at the time of service. Checks, cash, credit cards (except American Express) and the option of using your HSA card.
There is also a 24-hour cancellation policy or full payment will be applied. *Please read disclosure statement*
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Fort Mill Office

852 Gold Hill Rd.
Suite 206 
Fort Mill, SC 29708

Charlotte OFfice

2225 Freedom Drive
​Suite 2
Charlotte, NC 28208

Contact Us

EMAIL
COLLABORATIVECOUNSELINGGROUP@GMAIL.COM 
​
TELEPHONE NUMBER  
980-250-2438
  • Home
  • Who We Are
    • Staff >
      • Buffy Wimmer
      • Charles Wimmer
      • Gracia Blees
  • Services
    • Individual Counseling
    • Couples Counseling
    • Trauma Therapy
  • Client Forms
  • Contact
  • Donate
  • Year-end Letter