HARMONIUM COUNSELING SERVICES
Home
About
Services
Cost
Client Portal
Resources
Contact
HARMONIUM COUNSELING SERVICES
Home
About
Services
Cost
Client Portal
Resources
Contact
Contact
CONTACT
- WE ARE NOT ACCEPTING CLIENTS UNDER THE AGE OF 16 AT THIS TIME -
Name
*
First Name
Last Name
Email Address
*
Phone
*
(###)
###
####
Reason of Inquiry
*
Choose as many as apply:
Anxiety/Panic Attacks
Depression
ADHD
Grief
Relationship/Marital Issues
Family Issues
Substance Abuse
Legal Issues
Life Coaching
Other
How did you hear about us?
*
Doctor Referral
Counselor Referral
Friend/Family Referral
Internet Search
Psychology Today
Other
Insurance/Payment
*
Aetna
Ambetter
Anthem
Anthem Medicaid
ASR
Caresource
Caresource Medicaid
Cigna
Community Health Alliance
Indiana Medicaid/MDWise
Managed Health Services (MHS)
Meritain
New Avenues
Optum
Physicians Health Plan (PHP)
UMR
UnitedHealthcare
Self-Pay/Heath Savings Account (HSA)
Availability
*
Please indicate the days, and times of day, that you are available.
Location Preference
*
In-Office
Virtual
Either/Both
Thank you!