Mental Health Counselors | Marietta & Roswell

3855 Shallowford Rd Ste. 515, Marietta, GA 30062 | (678) 310-0358 | In-person In Marietta, Online Throughout GA

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New Patient Inquiries

New Patient Inquiries

It's time you felt heard and understood.

Your journey towards a brighter, more fulfilling life starts here.

Fill out the brief form below. We typically respond to your message within an hour during normal business hours and will assist you in scheduling an appointment or consultation.

First Name(Required)

Last Name(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Date of Birth(Required)

Please indicate who this form is for(Required)

Myself

A minor

Someone else

Please list the minor's full name and date of birth(Required)

Gender(Required)

Male

Female

Other

If this form is for you, please select your own gender. If this form is for a child, please select the child’s gender.

If this is for a minor, what is the minor's current educational setting?

Public School

Private School

Virtual School

Home Schooled

The minor is not in school

Other

If the minor is in school, please provide school name and grade.(Required)

How did you find out about us? (Check all that apply)(Required)

An insurance company

Internet search (e.g., google)

Referral from therapist or psychiatrist

Referral from other healthcare provider

Family member or friend

Professional organization (e.g., ABCT, ADAA, LPCAGA, LCSW)

Former or current patient we see

Other

Referring Therapist/Psychiatrist Name(Required)

Referring Healthcare Provider's Name(Required)

Do you have questions about insurance benefits?(Required)

Yes

No

At our counseling practice, many of our clients opt for self-payment for sessions. If you have inquiries regarding a particular insurance provider, please specify the name of the company. If choosing to self-pay for sessions, answer 'No'.

Your insurance company

What type of therapy are you interested in?(Required)

Tell us a little bit about your current challenges. Why are you seeking therapy now?(Required)

Would you prefer for us to email you to enroll you as a new patient or would you prefer a brief phone call from our Intake Coordinator to gather the necessary information for new patient registration?(Required)

Email

Phone Call

Location & Hours

3855 Shallowford Road, Ste 515
Marietta, GA 30062
Directions

Sunday, Closed
Monday, 8 AM–7 PM
Tuesday, 8 AM–7 PM
Wednesday, 8 AM–7 PM
Thursday, 8 AM–7 PM
Friday, 8 AM–7 PM
Saturday, 8 AM–6 PM

Scheduling

hello@awakencounseling.com

Extensions

Ashley Henry Ext. 2012

Ashley Hooper Ext. 2004

Caroline Skretkowicz Ext. 2013

Danielle Hajdini Ext. 2003

Gabby Brumfield Ext. 2008

Hannah Register Ext. 2007

Kristen Davenport Ext. 2006

Kristina Murr Ext. 2000

Megan Heller-Foley Ext. 2002

Molly Peterka Ext. 2011

Sarah Foster Ext. 2009

Shelly Eisenstadt Ext. 2005

Tuesdey Brown Ext. 2010

About Us
Our Services
Specialties
Educational Resources
- Awaken Blog
- Books
- FAQ
Treatment Approaches
Resource Links
New Clients & Fees

New Patient Inquiries

New Patient Inquiries

About Us
Our Services
Specialties
Educational Resources
- Awaken Blog
- Books
- FAQ
Treatment Approaches
Resource Links
New Clients & Fees

3855 Shallowford Road, Ste 515 Marietta, GA 30062
(678) 310-0358

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