Allied Counseling, Inc.
1. ADULT TREATMENT AGREEMENT
2. ADULT FACT REGISTRATION
3. ADULT PERSONAL REGISTRATION (22Q & U)
4. APPOINTMENT HOURS & FEES
A. Allied Pre-Paid Advantage Plan: Appointment Hours & Fees
B. Regular Sessions: Appointment Hours & Fees
5. FAST, SAFE, & EASY PAYMENTS WITH PAYPAL
Payment is made by selecting the Specific PayPal Session Cost Button that applies to you and all payments are made before the start of each session with PayPal accepting the same four credit cards in all countries (Amex, Visa, Master Card, & Discover). PayPal is both safe and easy to use. Simply follow the easy on screen instructions to complete payment by either logging into your PayPal account or checking out as a guest.
HELPFUL INSTRUCTIONS FOR COMPLETING ALL CLIENT FORMS:
The first three forms listed above; the Adult Treatment Agreement, the Adult Fact Registration, and the Adult Personal Registration must be scanned, signed and emailed to Dr. Austin (email@example.com) at the Allied Counseling Greensboro Corporate Headquarters in advance of your first appointment. When these 3 signed forms have been emailed, you can call the Allied Counseling Greensboro Headquarters at 1-336-706-1768 to be sure they have been received and we will help you schedule your first appointment.
Please feel free to call the Greensboro Corporate Office any time you have a question when completing these forms or want to schedule another appointment after you have registered. We try to answer all office calls and emails within 24 hours. Before Child or Adolescent counseling can begin, both parents (or legal guardian) must complete and sigh the above 3 forms plus the Child/Adolescent Fact Registration. Payment is always made before each appointment by using PayPal.
REASON FOR ALL ALLIED CLIENT REGISTRATION FORMS:
At Allied Counseling, the focus is on a humanistic whole person treatment approach that considers each client’s psychological, social, spiritual and physical well-being. Personal Facts and Job Titles can yield a great deal of information about a person, but they do so in a very specific and limited manner. Dr. Austin works with individual clients and corporate leaders helping them break through hidden personal filters of negative self-belief, limiting maldaptive coping strategies, and personal blind spots so as to never place a limit what they can achieve. All clients develop a creative individual treatment plan (ITP) to more successfully cope with the choices, chances and challenges they encounter. The goal of all psychological services at Allied Counseling is to help every client become more relaxed, happy, creative and successful and obtain the life they deserve. Dr. Austin has created a specific program called My Millennium Mind Exploration (MMM) to help children (ages three through eighteen) achieve these same goals. Dr. Austin looks forward to working with every client as they enjoy personalized counseling or corporate psychological services that maximize their privacy and convenience. Dr. wants clients to never forget the Allied Counseling Motto; “WORKING TOGETHER WE CAN CHANGE YOUR WORLD.”
6. CHILD/ADOLESCENT FACT REGISTRATION
7. MY MILLENNIUM MIND SELF EXPLORE QUESTIONNAIRE
For MMM clients ages 10-18 please fill this out by yourself
Clinical & Corporate Psychologist
Copyright © Dr. Austin Chandler