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Intake Request
 

Please visit our "More Information" page before submitting this form to learn more about availability, fees, and insurance.  

THIS FORM MUST BE FILLED OUT BY THE PERSON SEEKING THERAPY, USING ONLY THEIR INFO

We will follow up via email within 1-3 days.  If you do not receive a response within 72 hours, please contact us.

Are you a returning client?
When are you available for appointments? Required
Preferred Locations? Required

If you plan to use your health insurance benefits OR plan to submit your bill to your insurance for reimbursement of out-of-network services, please upload a picture of the front and back of your insurance card. Important: Those seeking couples or family counseling and those with Medicaid will not be able to use insurance for counseling and should not submit their insurance cards. Click here for more info.

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Contact Us

Lebanon Valley Counseling

Mental health counseling services for adults, older teens, couples, and families in Lebanon and surrounding counties

Text: 717-673-8419

Email: info@lebanonvalleycounseling.com

Lebanon Office Location:

1718 Grace Ave.

Lebanon, PA 17046

© 2023 by Lebanon Valley Counseling

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