Online Registration

Online Registration for
(Click One)
 A FT Appointment
 The Waiting List
 
Permission to Email a Confirmation Notice?
Yes
No
Email Address:
Address:
Date of Birth:
Referral Source:
Phone Number:
Permission to Leave a Message?
yes
No
Payment Method:
 Private (cash or check)
  Insurance
EAP Carrier
Insurance Policy Holder's Name:
 
DOB:
Secondary Ins Info:
NPCS schedules appointments Tuesday through Thursday 10.30 a.m to 6.30 p.m. Please indicate the days and times you're available for regular appointments.
 
I'm available the following times:
 
Yes
No
I am seeking (check all that apply):
Briefly explain the reason you are seeking counseling at this time:
Do you see a psychiatrist or doctor for psychiatric medications?
Yes
No
If yes, list the name and address of the doctor:
Are you seeking services for any of the following (check all that apply:)
Do you have any allergies or aversions to dogs that would prevent you from receiving services at NPCS?
Yes
No
Have you been a client at NPCS in the past? 
Yes
No
If so, did you have a different last/name?
Yes
No

Take the First Step

Click below to request your appointment