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Waitlist Form

If you would like to become a new client at Creekside Counseling Services, please fill out this form and our office staff will reach out to you when an appointment becomes available. Please note that we are a small private practice and wait times can vary. We cannot guarantee a specific time frame to start appointments. 

**Please note that currently we can only accept referrals for children ages 8 and up. 

**Wait times for appointments after 4:00p.m. can be multiple months out depending on current demand. Please call our office for more specific information about wait times and availability.

Waitlist Form

PLEASE NOTE:

Depending on your insurance provider, our Billing Specialist may reach out

with additional questions.

Please check all that apply Required
Type of Counseling Services you are Interested in (check all that apply) Required
Are you currently involved in any legal supervision

Thanks for submitting!

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