Let’s work together.

Honest Healing New Client Appointment Request.

Welcome to Honest Healing Therapeutic Services! We are honored that you are considering us for your mental health and wellness journey.

To get started, please complete this form. Our Intake Specialist will:

Verify your insurance coverage and out-of-pocket costs.
Contact you directly to complete a brief (15-minute) intake by telephone — available Monday–Friday, 8:30 AM to 7:30 PM.
Send you an email with your secure client portal access and required wellness forms once your intake is complete.

Important Notes

If you are a current or returning client, you do not need to complete this form again. Please contact us directly at office@honesthealing.org or call (661) 583-3142.
This form only needs to be completed once.

🌿Thank you for trusting Honest Healing Therapeutic Services. We look forward to supporting your healing and growth!

Name

First Name

Last Name

Phone

(###)

###

####

What services are you interested in?

Therapy

Life Coaching/ Case Management

Spiritual Guidance

Substance Abuse Counseling

Nutrition

Dance Cardio

Acupuncture

Insurance Carrier

We are in network with most insurance plans. If utilizing your insurance, please enter your insurance carrier below. Your benefits will be verified and your out-of-pocket costs (if any) will be confirmed. If not using insurance, our cash rates are $150/session. Please write n/a in all insurance fields.

Member/Subscriber ID

If you don't have your member ID, please put unknown. Additional information may be required to verify benefits.

Date of Birth

YYYY

For Couples or Family Counseling only, please provide the name of your partner/additional family members:

For couples Counseling and Family Counseling only, please provide the email address for all other participants over the age of 13.

If this is an EAP referral, please enter the EAP name AND authorization number, number of sessions, and effective dates. Please enter it below.

How did you hear about our services?