Home
Our Staff
Services
Telehealth
ASD Parent Support
Getting Started
Forms
Resources
Contact
Blog

We provide caring counseling services from the heart

Authentic Heart Counseling

My WordPress Blog

Schedule an Appointment

Forms

Client Intake Form

Please click the Client Intake Form link to complete forms prior to your first appointment.

(Mailing Address Only)
6520 Lonetree Blvd, suite 2001
Rocklin, CA 95765

916-827-4754
info@authenticheartcounseling.com

Name *

Email *

Phone

Therapist

Comment or Message *

Terms of Use *

Yes, I want to submit this form

By submitting this form via this web portal, 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 Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Phone

A Therapist Website by Brighter Vision

Copyright © 2023 · Bubbles on Genesis Framework · WordPress · Log in