Karvinen Counseling Services
Karvinen Counseling Services
Get Started
Please complete the required information below. Once submitted, we will contact you within one business day for scheduling and to answer any questions you may have. Thank you for reaching out and we will be in touch soon!
Today’s Date
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I am filling this form out for
myself
someone else
myself and a partner (for couples therapy)
If filling out for someone else, please list your name, relationship to client, and phone number
If filling out for a minor, what is their age?
Client Full Name
*
Client Phone Number
*
Preferred email
*
Type of session preferred
In person/at office
Video Sessions
Phone Sessions
Combination as needed
I don’t have a preference
Below is a list of insurance companies we are in network with. Please select all that apply below: (clients are responsible to determine service coverage through their insurance company).
Blue Cross Blue Shield
Cigna
HealthLink
Optum
United Health Care
UMR
None of the above (out of network)
No insurance (out-of-pocket fee)
Briefly list reason(s) for seeking services.
What is the preferred way you would like to be contacted for initial scheduling?
Text (fastest)
Phone
Email
Any additional information you want us to know? (preferred therapist(s), schedule requests, etc.)
How did you first hear about Karvinen Counseling Services?
Search Engine (Google, Safari, Bing, etc.)
Facebook
Instagram
Psychology Today
Word of mouth
Referral from a doctor or other professional
Other
Submit
+1-6186595411
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Text
+1-6186595411
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Call
admin@karvinencounseling.com
2220 South State Route 157 suite 200 d, Glen Carbon, IL 62034, USA
(Our suite is located on the second floor of the Meridian 2 building)
