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Ready for Change? Let's Get You Connected.

Taking the first step toward therapy shouldn't feel complicated. Complete the form below to tell us a little about yourself, what you're looking for, and your preferences. Our team will review your information, verify your insurance benefits if applicable, and help you explore the next steps toward getting started.


Completing For?

Important Instructions

If you are completing this form on behalf of a child or adolescent, please enter the child's information as the primary client and provide the parent/legal guardian information on the following page.


If you are requesting services for yourself or as a couple, clicking Next will allow you to submit the form without completing any additional sections.


Birthday
Month
Day
Year
Address
Therapist of Interest
Therapy Location
Health Insurance - Payment
How did you hear about BLISS Counseling & Consulting?
Community Event
Employee Assistance Program (EAP)
Facebook
Former Client
Friend or Family Referral
Google Search
Healthcare Provider - Therapist Referral
Instagram
Insurance Provider Directory
Psychology Today
TikTok
Other
If we are unable to contact you by email and phone, can we text you? Company phone: (205) 552-2370

By signing below, I hereby grant BLISS Counseling & Consulting permission to contact me about my inquiry, create a client portal if I choose to move forward, and/or utilize the information listed above to verify my health insurance benefits.

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If you have any issues submitting the form, please reach out to us directly at admin@balancelifecounseling.com. Email is the best form of contact. Include your name and phone number.

By submitting this form, you consent to receive communications from BLISS Counseling & Consulting, LLC, including information about services, programs, events, educational resources, practice updates, and promotional or marketing communications. You may opt out of marketing communications at any time by following the unsubscribe instructions provided or contacting our office. Opting out of marketing communications will not affect your ability to receive services or necessary communications related to your care.

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Please note: This form is not monitored for emergencies and should not be used to request immediate or crisis assistance. If you are experiencing a medical or mental health emergency, are in immediate danger, or believe you may harm yourself or someone else, call 911 or go to the nearest emergency department. For suicide or mental health crisis support in the United States, call or text 988 to reach the Suicide & Crisis Lifeline.

Address

2232 Victory LN Ste 900

Hoover, AL 35216

Phone

205 - 552 - 2370

Email

admin@balancelifecounseling.com

Crisis & Emergency Notice

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BLISS Counseling & Consulting, LLC does not provide emergency or crisis response services through this website, and website forms and messages are not continuously monitored.

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If you are experiencing a medical or mental health emergency, are in immediate danger, or believe you may harm yourself or someone else, call 911 or go to the nearest emergency department.

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For suicide or mental health crisis support in the United States, call or text 988 to reach the Suicide & Crisis Lifeline.

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