Request for Intern Services V202608

Request for Intern Services at CCD Counseling

Version 202608
Each semester, Master's level interns begin their final clinical training at CCD Counseling. During that training, they are supervised by a fully licensed clinician, but their fees begin at $10 per session, and then increase each calendar month until they reach $40*

We currently have 8 client slots available. By completing this form, you are requesting one of the 8 slots. Once we receive your request, we will email you to schedule, or to follow up with additional questions.

*Fee Schedule = September sessions = $10, October = $20, November = $30, December = $40.
If this is a life-threatening emergency, please call 911!

If this is not an emergency, but you need attention more quickly than we can provide, please call one of these other agencies:

Denton County MHMR - Call 800-762-0157

Dallas County Metrocare - Call 866.260.8000 or 844.672.5700
New Client Name

First NameLast Name
Is the new client an adult and able to consent for their own services?
We are sorry. Our interns can only see adult clients. Another low cost option for youth is our free Family Tree program. Learn more at https:\familytreeprogram.org
Contact Email - This is the email we will use to contact you. Please provide an email that you regularly check. If you don't hear from us, be sure to check your Spam or Junk folders.

Confirmation Emailexample@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Briefly describe the challenges you hope to resolve in counseling:
Preferred days/times for your counseling:
Please provide any additional information that might help us find you the best fit for your needs:
Should be Empty:

Request for Intern Services at CCD Counseling

Each semester, Master's level interns begin their final clinical training at CCD Counseling. During that training, they are supervised by a fully licensed clinician, but their fees begin at $10 per session, and then increase each calendar month until they reach $40*

We currently have 8 client slots available. By completing this form, you are requesting one of the 8 slots. Once we receive your request, we will email you to schedule, or to follow up with additional questions.

If this is a life-threatening emergency, please call 911!

If this is not an emergency, but you need attention more quickly than we can provide, please call one of these other agencies:

Denton County MHMR - Call 800-762-0157

Dallas County Metrocare - Call 866.260.8000 or 844.672.5700