Contact Community Counseling Associates

We look forward to serving you!

This form is to serve assist future clients and connect community leaders making a referral.

It is NOT be used for SEO marketing or job inquiries (please refer to the "Careers" tab)

Counselor Requested (if applicable) *

* Indicates required field

Name *

First

Last

Child's Name (if applicable) *

First

Last

Client Gender at Birth *

Male Female

Phone Number *

Email *

Type of Counseling *

If you are open to private pay, please indicate so in the box below. Private pay allows you to not receive a diagnosis and session time does not have to be spent meeting insurance requirements for sessions to be covered. Couples counseling is rarely covered by insurance.

Some of our staff have limited availability in network with insurance. Others offer sliding scale fees. If sliding scale is offered, insurance reimbursement is not available and not superbill will be provided. If wanting to use insurance, please indicate the insurance company name and describe if you have met deductible or copay amount. **Any sessions billed to insurance that later do not meet medical necessity in an audit will become the financial responsibility of the client receiving care. Insurance clients must be in the waiting room at the scheduled time of their sessions. If they are more than 10 minutes late, insurance will not cover the session in the alloted time and the session will be considered a late cancellation and the client will be responsible for the counselor's contracted rate not covered.

Please give as much detail as possible below. *

Please include any relevant information, including your availability (days/time range). *

Thank you for completing this form. We are excited about helping you find the best possible counseling match. We have been serving Collin Country and now Texas for over 25 years and are committed to providing you a comfortable environment, caring relationship, and outcome based treatment goals the will provide you with help and hope you need to heal.

You should hear back from someone by the end of the next business day. For faster service, feel free to call our on call staff number at 214-509-6888.

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Main Line/Counselor On-Call: (214) 509-6888

Fax: (214) 509-6887

We look forward to serving you!​This form is to serve assist future clients and connect community leaders making a referral. It is NOT be used for SEO marketing or job inquiries (please refer to the "Careers" tab)

We look forward to serving you!

This form is to serve assist future clients and connect community leaders making a referral.

It is NOT be used for SEO marketing or job inquiries (please refer to the "Careers" tab)