Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Joshua Center Location(s) *

Please mark any that would work for you

Fayetteville

Rogers

Conway

Siloam Springs

Jonesboro

Telehealth

Telehealth Counseling *

If telehealth is an option for you, we may be able to match you with a counselor faster. (Some client situations are not appropriate for technology assisted formats. We will do our best to serve all clients appropriately.)

I want to meet with my counselor via telehealth

Telehealth is ok, but would prefer to meet in person

I do NOT want to utilize telehealth, in-person only, please

Do you plan to use health insurance? *

Some health insurance covers mental health as part of their coverage. Not sure if your insurance provides this? Reach out to your benefits administrator at your employer and ask. We have several providers that accept Blue Cross Blue Shield insurance.

Yes - I have Blue Cross Blue Shield

Yes - But I do not have Blue Cross Blue Shield

No