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Thank you for considering Peaceful Solutions Counseling Inc. Please complete this form and we will get back to you, usually within the same business day. We look forward to helping you with the challenges of life and helping you on your journey to healing.
Name
*
First
Last
Reason for Contact
General Information
Want to start therapy
I am interested in
Individual therapy for myself
Therapy for my child (age 5-12)
Therapy for my adolescent (age 13-17)
Couples Therapy
Family Therapy
Child's Name (if client)
Primary health plan of client
Please select
Aetna Better Health Medicaid
Aetna Commercial Insurance
Ambetter Marketplace
Anthem BCBS Commercial Insurance
Anthem BCBS Medicaid
Caresource of Kentucky Marketplace
Humana Commercial Insurance
Humana Medicaid
Passport Health Plan Marketplace
Passport Health Plan Medicaid
UHC Commercial Insurance
UHC Community Plan Medicaid
UMR Commercial Insurance
Wellcare of Kentucky Medicaid
Therapist Requested (may have wait list)
Please select
Angelina Wedding LPCC (telehealth only)
Emily Dean MFTA
Hanna Faley LCSW
Jessica Pipalski LPCC (telehealth only)
Jill Ridgell CSW
Jordan Goings MFTA
June Dial LPCA
Kristen Fajack LMFT
Latoya Hall LPCC
Maddy Rhyne MFTA
Meredith Cundiff LPCC
Mia Angelini MSSW, CSW
Sarah Bauscher LPCC
Telehealth therapist
Phone
*
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Email
*
Question/Comment:
* Therapists sometimes have a wait list.
* We do not treat Autism. (high functioning maybe)
* We do not prescribe medications, however we can refer established clients for those services.
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