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TRUSSBRIDGE
COUNSELING SERVICE

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(423)-641-1517

Welcome to Trussbridge Counseling Service, Need Any Help ?

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Us

Thank you for your interest in contacting Trussbridge Counseling Service. Please complete this form to help us understand your needs.

This form is not for emergencies. If you are in immediate danger, please call "911" for emergency and "988" for crisis hotline.

Contact Information

First name*

Last name*

Email*

Phone*

Preferred Method of Contact*

Phone

Text

Best Time to Contact You*

Client Information

Age*

Are you seeking services for:

Address*

Services You’re Interested In (Select all that apply)*

Individual Therapy

Couples Therapy

Family Therapy

Psychological Assessment

Other

Brief Description of What Brings You In*

Provider Preferences (Optional)

Do you prefer:

In-person

Telehealth

Either

Safety Check

Are you currently experiencing thoughts of harming yourself or others?*

Yes

If yes, please call "911" for emergency and "988" for crisis hotline immediately. This form is not monitored in real time.

How Did You Hear About Us?*

Google / Website

Referral

Social Media

Insurance Directory

Other

Consent & Submission

I understand this form does not establish a therapeutic relationship.

I understand my information will be kept confidential in accordance with privacy laws.

WORK WITH US

Go ahead and schedule your first free consultation, and let us talk, reflect and decide the way to go! I am excited to know you. LET’S DO IT!

Schedule Your Call

Phone

(423)-641-1517

Fax

(423) 464-5149

Hours

Monday–Thursday

8:00 am – 6:00 pm

Fridays and Sundays

8:00am -1:00pm

TRUSSBRIDGE COUNSELING SERVICE

Location

1510 Stuart Road Suite 102A Cleveland TN, 37312

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