Living Water Counseling Ministry- Virginia and North Carolina Telehealth Counseling

Mental Health Counseling, Christian Counseling, Substance Abuse Counseling

" ...If you knew the Gift of would have asked of Him, and He would have given you Living Water." (John 4:10 KJV) 

Health Insurance Contact Form

All of my counseling sessions are Telehealth Only, no in-person sessions. So you will need access to the internet, your own phone for counselor to get in touch with you in case of technical difficulties, and your own email address where you can receive appointment reminders and document requests. *
You must have access to your own personal email address in order to access appointment reminders, document requests, and other aspects of Telehealth Services.
Do you have an active Medicare policy?*
Please be aware that counselor is NOT In-Network with Medicare (as Medicare will not accept Licensed Professional Counselors as providers at this time) so you will be given Self-Pay Costs.
Do you have an active Medicaid policy?*
Have you been court ordered for counseling services or was it recommended by your lawyer, Child Protective Services, or the Department of Social Services? *
Please be aware that Telehealth Counseling services may not be an approved level of care for court related counseling services.
Do you have current or pending legal issues? *
Please be aware that Telehealth Counseling services may not be an approved level of care for court related counseling services.
Have you had any recent Hospitalizations (due to mental health or substance abuse issues), In-Patient Counseling Services, or time served in jail/prison? *
Appointment Hours are currently: Monday and Wednesday 11:00 am-5:00 pm Tuesday and Thursday 9:30 am-5:00 pm
Once per week, Twice a month, Once a Month, Unsure depends on client costs, etc.
Example: Depression, Anxiety, Trauma, Substance Abuse, etc.
The one listed with your insurance provider
Example: Anthem, Blue Cross Blue Shield, Virginia Premier, etc
For Medicaid clients please list the member ID with your insurance provider (Anthem, Virginia Premier, United Healthcare etc), NOT your Virginia issued Medicaid number.
Found on the back of your insurance card
If you are on your spouse's or parent's insurance.
Listed with the insurance provider
By checking Yes I acknowledge and understand that not all issues/problems are appropriate for mental health counseling services. If at any time my counselor feels I would benefit more from In-Person Counseling Sessions then I will be given referrals to other providers in the area. I understand that during the Initial Counseling Session the counselor and I will discuss my counseling goals/objectives and determine if Telehealth Counseling is appropriate for me and if the counselor is a good fit for my needs. *
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