Request an Appointment | Charis Counseling Centers

To request an appointment, please complete the form below. Or you may call us at 508-947-1901 and leave a voice message. Our intake coordinator will respond to all telephone and online inquiries within 24 hours, Monday to Friday. If you contact us on the weekend, we will be in touch the next business day. Thanks!

Please complete the form below.

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Name*
FirstLast
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Email*
Phone*

Name of Your Insurance Provider*
Name of Policy Holder*
Identification Number of Primary Client*
Date of Birth of Primary Client*
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DD
YYYY

Brief Description of Your Concern(s)
This will help us match you with the counselor who best fits your needs at Charis.
Your Availability
Please let us know the day(s) of week and times of day when you are available to come for counseling. This will also help us match you with a counselor.
Email
This field is for validation purposes and should be left unchanged.