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Counseling Referral

To receive counseling fill out the entire form below. If you need assistance in filling out your referral please call (704) 537-7775. 
[You will receive an email within 2-3 business days with your digital intake paperwork.

Is the patient a minor
Gender (insurance purposes only)
Please check your preferred availibility

Thank You!

Please check for an email from Christ Centered Community Counseling to fill out your digital paperwork.

Check your spam if you have not received the email in 3 business days. 

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