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Refuge Wellness Counseling Services

  • About
  • Services
    • Work and Career Issues
    • Stress Management
    • Depression And Anxiety
    • Couples Counseling
    • Family Counseling
    • Addiction And Recovery
    • Conflict Resolution
    • Grief Counseling
    • Intimacy and Relationship Issues
    • Parenting and Family Issues
  • FAQ's
  • Forms
  • Contact Me
  • Client Portal
  • Links & Resources
  • Privacy & Policy

Refuge Wellness Counseling

  • About
  • Services
    • Work and Career Issues
    • Stress Management
    • Depression And Anxiety
    • Couples Counseling
    • Family Counseling
    • Addiction And Recovery
    • Conflict Resolution
    • Grief Counseling
    • Intimacy and Relationship Issues
    • Parenting and Family Issues
  • FAQ's
  • Forms
  • Contact Me
  • Client Portal
  • Links & Resources
  • Privacy & Policy
(601) 759-1104
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Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, Click here.

Visit the Office

--mi
Address

101 Avalon Ct Suite B
Brandon, MS 39047

Contact Information (601) 759-1104

[email protected]

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