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) 

Self-Pay 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.
If you do have insurance but are choosing not to file with your policy please give a brief explanation why
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, Tuesday, Wednesday, and Thursday 11:00 am to 5:00 pm No Hours Available on Friday, Saturday, or Sunday at this time.
Once per week, Twice a month, Once a Month, Unsure depends on client costs, etc.
Counselor is only licensed to practice in the states of Virginia and North Carolina.
By checking Yes I acknowledge and understand that not all issues/problems are appropriate for Telehealth 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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