Ready to Get Started?

3 Easy Steps

1) Complete this form. We’ll contact you with any questions we have and to answer any you have.

2) Respond to our follow up email from start@qualitycounselingne.com.

3) We will contact you to schedule your first meeting. Therapists call this an intake. At this meeting, your therapist will ask you more questions about who you are and what your needs are. You’ll get your first chance to meet your therapist and you can decide if you feel comfortable giving therapy with that therapist a try. If not, we’ll give you suggestions about other options.

Quality Counseling of New England

245 Waterman Street, Suite 107

Providence, RI 02906

start@qualitycounselingne.com
401-722-5026

Your Legal Name

First Name

Last Name

Your preferred name

(if different from above)

Your preferred gender pronouns (optional)

Phone

Help us reach you.

(###)

###

####

Address

Street Address, City, State & Zip Please

Date of Birth

How did you hear about us?

Reason for contacting us

Let's get your first appointment booked. Or send us your questions.

I want to accept myself. Email me the link to the practice paperwork.

I'm ready to start anxiety therapy. Email me the link to the practice paperwork.

I want to work on relationship challenges. Email me the link the the practice paperwork.

I have a question about starting one-on-one counseling.

I'm interested in an anxiety reduction group.

I'm an educator who wants CBT.

Reason for seeking therapy

Give us a brief description of why you are seeking therapy (a few sentences is fine).

Questions for April before you get started?

If you have one, let us know here.

We respond to every message. Usually on the same business day (with exceptions for holidays and vacations). If you’re ready, you could have your first appt in less than a week.

Ready to Get Started?

3 Easy Steps

start@qualitycounselingne.com401-722-5026

start@qualitycounselingne.com
401-722-5026