CONTACT US/APPOINTMENT

You can fill this form out to set up an initial therapy session at Best Life Counseling and Coaching. Once we receive this information, my office manager, Amanda will call you and set up the appointment. If you provide your insurance information on this form, she will likely be able to get your benefits before she calls you back. Then, you will be able to get in quicker than just leaving a voice mail at our office. Looking forward to helping you live your best life.

Best Life Counseling Contact Form
Please note that all fields followed by an asterisk must be filled in.
First Name* First Name*
Last Name* Last Name*
E-mail Address* E-mail Address*
Street Address* Street Address*
City* City*
State/Prov* State/Prov*
Zip/Postal Code* Zip/Postal Code*
Country* Country*
Home Phone* Home Phone*
Business Phone
Insurance Information
Name of Insurance Company/ EAP
Phone Number of Insurance Company/EAP
Your Insurance ID/Subscriber ID
Date of Birth/We need so we can get your insurance coverage

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