Request appointment | Beelong Counseling

Request an appointment

For Minor Clients: Who has the legal authority to consent for this minor (check all that apply:)

both biological/ legal parents together Biological parents are separeted and share legal decesion making (both must consent) One parent has sole legal custody (paperwork required) court-appointed legal guardian foster parent (if authorized to consent) adoptive parent(s) grandparent with legal guardianship other (please explain): N/A, service not for a minor

For Minor Clients: name and contact information for both parents.

(First and Last Name, email and or phone number to best contact at) if an adult write NA

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.