Appointment Request - Confidential
The Peacemaker Center
If this is an emergency, please dial 911.
New clients who want to set up an appointment should complete this form and click the submit button. You will be asked to sign our consent and both forms will be submitted securely to our Intake Coordinator for review and assignment to a therapist who will reach out to you to schedule your initial appointment.
Client #1 Information
Client #2 Information
Client #3 Information
Client #4 Information
We do not take insurance and are not in network with insurance companies but, when requested, our therapists will provide a receipt with the proper codes, that can be submitted to your insurance company for out-of-network reimbursement of our fee.
Our fee is based on a sliding scale with full pay on the scale set at $150 per 50-minute session. We can offer a reduced fee to those in need, based on our sliding scale through The Peacemaker Center Scholarship Program. This is offered on a first come, first serve basis and is limited to 12 sessions followed by re-evaluation. Your fee and use of scholarship funds is determined by your therapist. When available our interns provide quality counseling at a reduced rate.
Sponsorship is provided by community and church support through donations with 100% of the funds raised used to pay for direct client care. If you or someone you know are interested in donating to our Scholarship Fund please donate through our website at www.thepeacemakercenter.org, or mail a check to 103 Garris Rd, Downingtown PA 19335 or contact us at 610-269-2661. Donations are tax deductible with receipts available upon request.
If you have an individual, church, or organization sponsoring you, please indicate the following: Sponsor Name Sponsor PhoneSponsor Email # of Sponsored Sessions