New Client Form

To become a new client, please fill out the form below.

By filling out this form, you are consenting to the use of electronic communication. If you do not consent to the use of electronic communication, you may also call our office to begin services at (866) 644-6131. Please note that our phone line hours are limited at this time to Monday through Thursday, from 9am to 5pm. Voicemails left will be returned within 48 business hours

If you are a private pay client, not using insurance, and DO NOT plan to use out-of-network benefits to receive reimbursement from your insurance company, please make sure you indicate that below so that you may be provided a "Good Faith Estimate" of the estimated cost of services.

To begin services, please enter the following information:

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Do you give consent for us to contact you via email? *

Location Preference *

Type of Service *

Type of Payor *

Type of Insurance (if applicable)(type N/A if not applicable) *

Preference *

Appointment Day Preference *

Appointment Time Preference *

Are you calling in for your child? If so, what is your name? *

Is the client under 12 years of age? *

If under 12 years of age, are both parents consenting to treatment? *

Is there current DHS involvement? *

Are you looking for an LGBTQIA+ affirming/ally clinician? *

Are you a previous client of Barber Family Counseling & Wellness? If so, who did you used to work with? Would you prefer to work with them again if there is an opening? *

Are you a current client of Barber Family Counseling & Wellness being referred to another provider for a different type of service? *

Is there a specific clinician you would prefer to work with? *

Submit

Location

Colorado Springs, CO
4775 Barnes Rd. Ste L
Colorado Springs, CO 80917

Las Vegas, NV
1771 E Flamingo , Ste 220-B (Bldg B)
Las Vegas, NV 89119

Y

Phone: (866) 644-6131
Billing Questions: (866) 644-6131 ext 701
Fax: (719) 434-9615
wellness@barberfamilycounseling.com

Appointments available week days, evenings and weekends.

Our phone lines are monitored Monday - Thursday, from 11am-3pm for faster methods of contact, please use the following resources:
To inquire about or to begin services: Please click here.
For general Inquiries: Please click here.
For billing Inquiries: Please click here.

If you or someone you know is in crisis, call 911, go to the nearest emergency room, or call 1-800-273-TALK (8255) to reach a 24-hour crisis center.

You matter and you are never alone.

YOUR CART

To begin services, please enter the following information:

Location