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Home
About Us
Background
Meet Our Midwest City Team
Meet Our OKC Team
Meet our Virtual Team
Edmond Team Coming Soon!
Services
Christian Counseling
Couples Counseling
Family Challenges
Individual Therapy
Pastoral Care
Substance Use & Addiction
Virtual Services (Telehealth)
Youth Issues
Costs
Rates/Insurance
Out-of-Network (OON) Benefits
Self Pay
Resources
Articles
Social Media
Community Resources
FAQ
Contact
Contact Us
Referral Form
Share Feedback
Client Portals
Therapy Appointment Portal
Secure Pay Portal
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Clinician Discharge Survey
Name of client
*
Admit Date
*
Discharge Date
*
Original Reason For Seeking Services:
*
Services Provided:
*
Individual Therapy
Family Therapy
Couples (Unmarried) Therapy
Marriage Therapy
Group Therapy
Case Management
Goals met?:
*
Reason for terminating services:
*
Completed treatment
AWOL
Deceased
Failed to begin treatment
Incompatible with services
Incarcerated
Moved away
Needed different services
No longer eligible for services
Parent/custodian discharged
Client terminated services without explanation
Resources or referrals needed?:
*
Aftercare/Support Needed:
*
Comments:
Submit
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