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New Client Interest Form
Intake Information
Our Team
About Dr. Webb
ADHD
Autism
Anxiety
Behavior
Presenter
- Stop Struggling Podcast
- Professional Development
Stop Struggling Blog
More

Use tab to navigate through the menu items.

New Client Information

First and Last Name

Email

Phone

Preffered Method of Contact

Phone

Email

Text Message

What is the best time to contact you?

What are the issues you want to address with counseling?

Were you refered by anyone? If yes, who?

Are you using an insurance provider, self-paying, or other method (e.g., HSA/FSA), *Our office manager will confirm your insurance benefits or payment arrangements before scheduling.

Available Days/Times for Appointments:

Morning

Afternoon

Evening

*I need specific days/ time (please leave in additional comments)

Any additional comments/ questions?

We will get back with you shortly.

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