If you are interested in receiving counseling services, please call the Briskin|Wilder Welcome Center at 310-217-9999 and our Care Associate will assist you.
Please do not complete any forms until our Care Associate guides you through the process of commencing services.
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.
There are 2 different options to submit the Intake Form.
- Download this PDF Adult Intake Form and email the completed form to firstname.lastname@example.org. *Note for couples: We would like each partner to complete the form.
- Electronically complete through DocuSign here. Once completed you will receive a copy of the completed form(s). *Note for couples: We would like each partner to complete the form.
This ensures your therapist will be able to familiarize him/herself with this important information before your intake appointment. Thank you for your cooperation.