New Clients

We’re so glad you found your way here! It’s a courageous first step to reach out for you or a loved one.

Please fill out the form below to request a new client appointment or consultation.

Someone will reach out to you as soon as possible regarding scheduling and online paperwork to complete. If you haven’t heard back within 24 hours, it’s possible your form was lost in cyberspace, so please feel free to call, text, or email again!

*Please see the FAQs and policies pages for more info for new clients, including fees & payment and cancellation policies.

Also, it is so very important that there is a good fit between the client and therapist. We are happy to schedule a free 10-15 minute “meet and greet” to chat and answer any questions. Please indicate this on your form. And this goes for at any point during therapy, as well! We want your feedback so that your needs are met!

Name of Client *

First

Last

Email *

Phone Number

Client's Date of Birth *

Guardian Name (If Minor)

First

Last

Clinician Preference *

What brings you, or your child, to our office? What are your goals? *

How did you hear about us? *

Please let us know who we can thank for sending you our way!

I acknowledge that Sun Counseling and Wellness is a self-pay practice and does not accept insurance. Full payment will be due at time of service. A super bill can be provided for potential out-of-network reimbursement. The ONLY exception is for the dietitian (Lindsey) who is in-network with BCBS. It is the client's responsibility to determine benefits and the client will be fully responsible for payment.

Yes, I want to submit this form.

By submitting this form via this website, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Sun Counseling & Wellness/Juliet Kuehnle LCMHC PLLC harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

New Clients

Let's Walk Through it Together.

5970 Fairview Rd, Suite #126, Charlotte, NC 28210

subscribe to our newsletter!

Pages

Therapy