Cape Fear Oasis Counseling & Consulting Services Contact Us

For new clients ready to take the next step, fill out the form below to get started.

New Client Intake Form

Name

First Last

Preferred Pronouns

Date of Birth

Caregiver name (if applicable)

First Last

Client or Caregiver Email(Required)

Client or Caregiver Phone Number

Service(s) Requested

Trauma Informed Comprehensive Clinical Assessment

Individual Therapy

Family Therapy

Group Therapy

Couples Counseling

Clinical Supervision

Seminar/Training

Consulting

Insurance or Self Pay?

Insurance Provider

Policy Number

Briefly describe reason/concern for reaching out!

If you were referred to us, please let us know who sent you!

Ph. 910-408-8473