Request an Intake Appointment

Please complete the form below so that we can match you to a clinician that will best fit your needs. We will contact you within 48 hours to confirm receipt of your submission, explain next steps, and connect you with one of our licensed counselors. Also, the majority of our clinicians are private pay and do not accept insurance. However, all counselors accept HSA/FSA, can help you receive out of network benefits from your insurance company, and offer sliding fee scales.

Client Seeking Services

First Name

Last Name

Client Age

Guardian name if client is a minor/under 18yrs.

*Note: We currently do not have clinicians who can see children under the age of 13.

First Name

Last Name

Email Address

Phone

(###)

###

####

Select a Service

Session Style

Note about telemental/virtual sessions: The ethics of a licensed counselor only permits counselors to practice in the state in which they receive their license. For Ohio licensed Veritas clinicians, any client they see must be physically present in the state of Ohio during a counseling session (the counselor, however, can see a client from anywhere).

Counselor Gender Preference

Preferred Availability (check all that apply)

Weekday daytime

Weekday evening

Weekend mornings

Reason for Seeking Services

Please briefly share why you are requesting a counseling intake session.

Referred By

Were you were referred by a specific medical professional, community organization, school, current Veritas client, etc.?

Additional Comments

Is there anything else that would be helpful for us to know in advance?

Learn more