Associates in Christian Therapy Services

Therapy Process for Couples Therapy Process for Individuals Therapy Process for Families

Being Relevant in Today's Hurting Community

How do I make my first appointment?

You may call André, our intake worker, at 1-800-417-6966, ext 0. He is available to receive your call from 9 am to 9 pm Monday to Saturday. André will be happy to answer any questions you may have and once the fees have been established, will assign you to the therapist.

You may also download our intake form and fax it to 1-800-417-6966, once it is completed.

You may also fill out the online form below and André will get back to you within 48 hours.

ACTS Intake Form

Note: Fields with * are required

Personal Information

First Name*:

Last Name*:

Home Phone Number*:

Can we leave a message at home?


Work Phone Number:

Can we leave a message at work?


Cell Phone Number:

Can we leave a message on your cell?


Email*:

Confirm email*:


Therapy Information

I/we are looking for


Briefly describe what you would like to discuss in therapy.

Have you been in therapy before?


If yes, when were you in therapy?

Type of therapy received?

Approximate duration of previous therapy:

With whom/which organization provided the service?

ACTS offers the integration of faith (such as prayer and/or Scripture) in sessions to clients who request it. Please indicate your preference.



Appointment Information

Which location would you like to have services?


What is your general availability?

Morning

Afternoon

Evening


Fee Information

Note: ACTS uses a sliding fee scale geared to income

What is your household's gross annual income?

How many people depend on this income?



General Information

How did you hear about ACTS?


Do you attend a local church?


If yes, which one?