Form cover
Page 1 of 3

Change of Counselor Form

Instructions: Submit to request a change in counselor. Our Intake Team will contact you within 1-3 business days to discuss next steps.

Reason to request new Counselor:

Reason to request new Counselor:

Current Counselor's Name:

Desired Location is:

(select all that apply)
Desired Location is:

Available day and times for sessions:

Example: Wed 7-9pm (online)