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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 availability

Thank You!

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

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

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