Group Intake Form

Group Therapy Intake

If you are interested in receiving counseling services, please call the Briskin|Wilder Welcome Center at 310-271-9999 and our Care Associate will assist you.

Please do not complete any forms until our Care Asociate guides you through the process of commencing services.

INSTRUCTIONS ONCE YOU HAVE SPOKEN TO A CARE ASSOCIATE

Payment

In order to proceed with your intake appointment, The Maple Counseling Center kindly requests payment of the $35.00 intake fee. You can complete this payment by clicking the link below when instructed by our Care Associate.

Form

There are 2 different options to submit the Group Therapy Intake Form:

    1. Download this PDF Group Intake Form and email the completed application to intake@tmcc.org
    2. Electronically complete the form through DocuSign here. Once completed you will receive a copy of the completed form(s).

All intake forms must be submitted the day before your intake appointment.

This ensures your therapist will be able to familiarize him/herself with this important information before your intake appointment. Thank you for your cooperation.