KINGDOM CREATIVE COUNSELING PLLC
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  • TRAINING FOR CLINICIANS
  • Dr Samaria M Colbert
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  • Make A Referral
  • SCHEDULE YOUR SESSION
  • PRESS RELEASE

​INTAKE FORMS & INSTRUCTIONS


If your forms are not completed at least 24 hours prior to your appointment, your appointment will be canceled.  Your virtual packet will be emailed to you. Of if you would like print out the forms and fax it to us at (336) 663-2906
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We have attached our paper intake forms for your convenience. For office based sessions you have the option of completing the virtual forms or a paper form. To complete paper forms print, complete and fax them to (336) 663-2906. Otherwise the packet will be emailed to you at the email address you provided us.

We will let you know what your out of pocket payment is prior to your session. An invoice will be emailed to you. All forms of credit are accepted. Personal checks are not accepted. For your convenience you may pay your copay in advance. However be mindful that final out of pocket payment is not confirmed until we hear from your health care provider.


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  • Home
  • About
  • Services
  • FAQ'S
  • TRAINING FOR CLINICIANS
  • Dr Samaria M Colbert
  • PODCAST
  • INTAKE FORMS
  • Make A Referral
  • SCHEDULE YOUR SESSION
  • PRESS RELEASE