contact us

Use the form on the right to contact Heart to Heart Counseling.

2365 Lakeview Dr. Suite B
Beavercreek, OH

New Client Forms

Due to Insurance companies updating their rates, we must also change our rates and payment options in order to stay aligned with them. Starting January 2021, our Self-Pay rate will be increasing.

$150 - 60 Minute Individual Sessions, Intakes, Family/Couples Session and Sessions without the Client Present.

$125 - 45 Minute Individual Sessions.

$150 - Telehealth Sessions.

download intake forms to save time at your first appointment.

In order to open and print the forms, you may need to install the free Adobe Reader program HERE.

please print and fill out these two forms, and bring them to your first appointment:

TeleHealth Consent Form

New Clients over 18:

Adult Intake Form

Adult Fee Agreement/Consent Form

 

New clients under 18

Under 18 Intake Form

Under 18 Fee Agreement/Consent Form

Early Development Parent Form

Symptom Measure — Child Age 11-17

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