Wishing You Well Counseling Center
21731 Timberlake Road
Lynchburg, VA 24502
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New Patient Information

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Please download, print, and complete the Client Information Sheet and Services Agreement form. (Note: Adobe Reader required. If you do not have Adobe Reader on your computer, you may download a FREE copy from Adobe here.)

If you are completing this form for a child, please use the child’s name and information to fill out the forms.   

Bring the forms to your first appointment. If you have any questions, your counselor will assist you during the intake.

Client Information Sheet & Services Agreement form PDF
File Size: 195 kb
File Type: pdf
Download File

To set up an appointment, contact our office manager at 434-455-5033
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