• Celebrating 10 Years of Service in the
    New River Valley!
    Happy 10th Anniversary Life In Balance!

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    Counseling Intake Packets

    lifeinbalancecenter@gmail.com | 540-381-6215

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    Counseling Intake Packets

    For your convenience, use the links below to print and complete your paperwork prior to your initial appointment.

    Notice Of Privacy Practices – All Clients Please Read

    Adult Intake Packet

    Child Intake Packet

    Covid-19 Informed Consent of Risk

    Telehealth Consent Form

    Consent for Treatment of Minors
    (required only if there is a custody agreement in place.)

    Please remember to bring your photo id, insurance card, and any custody agreements that may be in place along with your completed packet to your initial appointment. Failure to do so may result in having to reschedule.

    If for any reason you cannot keep your appointment, please notify the office at least 24 hours in advance. Failure to do so may result in missed appointment fees or inability to reschedule.

     

    Life in Balance Counseling & Wellness Center

    400 Roanoke Street

    Christiansburg Virginia 24073

    lifeinbalancecenter@gmail.com

    540-381-6215

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