TPC Logo Transparent.png

We are accepting new clients for Telehealth and In-Person sessions.

New Clients

If you are a new client please complete our confidential Appointment Request form below. It will be submitted securely to our Intake Coordinator for review and assignment to a therapist who will reach out to you to schedule your first appointment.

 

Current Clients

Current clients complete additional forms below when requested by your therapist.  

Rates

The Peacemaker Center does not take insurance and is not in network with insurance companies. Upon request, our clinicians will provide a receipt with proper codes that can be submitted to your insurance company for out-of-network reimbursement of our fee.

 

Our fee is based on a sliding scale with full pay set at $125/fifty-minute session. We can offer a reduced fee to those in need, based on our sliding scale. 

Client Forms

 
 
Computer Keyboard

Appointment Request

New clients who want to schedule an appointment complete our confidential Appointment Request form. 

Computer Keyboard

Depression

Screening

Scheduled clients, at the request of your therapist, fill in the Depression Screening form.

Computer Keyboard

Couples Accessible, Responsive, Engaged Questionnaire (A.R.E.)

Scheduled clients, at the request of your therapist, fill in the A.R.E. Questionnaire.

Computer Keyboard

Scholarship

Approval

Clients with financial concerns should complete the Scholarship Approval form along with the Appointment Request Form.

Computer Keyboard

Release

Scheduled clients, at the request of your therapist, fill in the Authorization for

Release form.

Computer Keyboard

Feelings List

Scheduled clients, at the request of your therapist, fill in the Feelings List.

Computer Keyboard

Consent

Scheduled clients sign and submit the Consent form unless you have signed it through our Client Portal.

Computer Keyboard

Consentimiento para Tratamiento

Los clientes programados deben firmar y enviar el consentimiento a continuación, a menos que lo haya firmado a través de nuestro portal de clientes.

Computer Keyboard

Life

History

Scheduled clients complete and submit the Life History form unless you have completed it through our Client Portal.

Computer Keyboard

Couples

Dyadic Adjustment Scale

Scheduled clients, at the request of your therapist, fill in the Dyadic Adjustment Scale.

© 2021 The Peacemaker Center.

All Rights Reserved. 

Privacy Policy