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Counseling Services Referral Form
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- REFERRAL SOURCE
  
  AGENCY NAME REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Please Check Your
  Preferred Location Below
- CHECK ONE REQUIRED Mooresville Location Concord Location Charlotte Location Please fill out this field.
- Name of Person for whom Services are Requested
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
- Guardian's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian Contact Information REQUIRED Please fill out this field. Please enter valid data.
- Primary Insurance REQUIRED Please fill out this field. Please enter valid data.
- Why are you Seeking Services? REQUIRED Please fill out this field.
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Doxy.me user Instruction Video (Below)

In this time of social distancing due to the COVID-19 Virus, we have instituted TELEHEALTH to help you visit with our therapy staff to obtain the help you're seeking in a safe manner while you are at home. You can access Turning Points TELEHEALTH through your desktop computer, a tablet, or your smartphone.

Please click on the link to the right of each therapists name below to be connected.

Name	Doxy.Me link
Melissa Sackowitz - Physicians Assistant	https://doxy.me/tphmelissapa

Sarah Sudol	https://doxy.me/sarahsudol
Jamie Venzian	https://doxy.me/jamiev
Cindy Hegenbart	https://doxy.me/cindyturningpoint
Marissa Wells	https://doxy.me/mwells12
Mike Vroom	https://doxy.me/mikevroom
Janine Denoncourt	https://doxy.me/janineschoolbasedmentalhealth
Sonya Warren	https://doxy.me/sonyaturningp
Cheyenne Gregg	https://doxy.me/cheyennegregg