Counseling

The Clinical Services Coordinator, who receives all new counseling referrals, is out of the office until 5/6/24. You/your referral can expect to hear follow up from Jasmine after that date. If you are in need of urgent care or services, please call 911 or contact the mobile crisis unit, 866-275-9552. If you’re in need of resources in general, www.findhelp.org may be useful.

Please note that there is a wait list for counseling at Family Services right now. If you submit a referral form, Jasmine will follow up when she returns to discuss the length of the wait, and options with you. To look at other available counselors in Forsyth County, you can go to the Psychology Today Therapist Finder tool, and specify insurance, specializations, and more. Thank you, we will be back in touch with you soon!

 

Professional Referral Form

This referral form is meant to be used by medical and mental health providers and other agencies, organizations and professionals seeking to initiate outpatient counseling services for clients in their care. If you have any additional documentation you wish to share concerning a referred client, please attach to this form or email them directly to Jasmine Stimac at Family Services, jstimac@familyservicesforsyth.org.

"*" indicates required fields

Client Information

Client’s Name*
Parent or guardian’s name if client is a minor
MM slash DD slash YYYY
Please select the primary spoken language of the client*
Please select the primary spoken language of the Parent/Guardian
Address
Insurance Information*

Family Services is In-Network with Blue Cross Blue Shield (except for the Blue Local plan), United Health Care, and accepts Medicaid (for counties within Cardinal Innovations Managed Care Organization) and NC Health Choice. We also accept out-of-network insurances and self-pay clients.

Referrer Information

Complete this section so we can contact you after the referral has been made.

Has the client been made aware that you are referring them?
Max. file size: 50 MB.



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