Intake Registration & Scheduling

Intake Registration and Scheduling

Required to create your chart and schedule your first appointment. Please call our office at (843) 894-0000 if you have any questions or concerns while completing this form.
Step 1: Complete this form.

Step 2: We will check insurance eligibility.

Step 3: We'll call you to select the appointment time!
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number. You agree to be contacted. Text message rates may apply.Format: (000) 000-0000.
Email*
example@example.com

Submit below!
Thanks for completing this form! We'll be in contact with you very soon!

If you don't hear from us by the next business day, please call us at (843) 894-0000
How did you hear about us?*
Anything else you would like us to know?
Signature*

l certify that the information above is accurate and complete. I agree to be contacted by Oceanic Counseling Group LLC.
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Intake Registration and Scheduling