Appointment Form for New Patients

  • Please complete this form if you would like to be a new patient with Atlantic Counseling. We are offering Telehealth services to new and active patients.

  • Street address, apartment/ unit number
  • City/ Town, State, Zip code
  • Individual/Family/Couples counseling. Medication consultation (limited availability)
  • Please answer the following questions to the best of your ability.

  • Responses will be sent by email. Please contact the office if you have not received a response within 5 business days.