port orange counseling youth intake form iconCONFIDENTIAL INTAKE FORMS – Adult [click to view and print]

port orange counseling youth intake form iconCONFIDENTIAL INTAKE FORMS – Youth [click to view and print]

We encourage you to print and complete the Intake Forms and bring them to your initial appointment. The Intake Form is also available at our office and you may complete it there if you prefer.
 If so, please arrive 15 minutes prior to your scheduled appointment time.

ADDRESS:
4639 S Clyde Morris Blvd., #107
Port Orange, FL 32129
MAP & DIRECTIONS:
PHONE:
(386) 492-6938
EMAIL:
Email any of our caring counselors at:
wecare@waycounseling.com
WE ARE OPEN:
By Appointment
Monday – Friday: 8:00 AM – 8:00 PM
SEND US A MESSAGE:

happy family playing baseball

There IS Hope. Contact us today.

Janice Suskey, M.Ed, Ed. S, Licensed Mental Health Counselor, MH8418 Michael McCrory, MS, Licensed Mental Health Counselor, MH12149 Michelle M. Tolison, MS, LMHC, Licensed Mental Health Counselor, MH13144 Bob Kemp, MAC, Registered Mental Health Counselor Intern, IMH7790 Michele Houseworth, LCSW, Licensed Clinical Social Worker, SW12813
David Shoots, LCSW, MTh, Licensed Clinical Social Worker, SW6973

Michael Hankes, MS, Licensed Mental Health Counselor, MH13623
Russell Holloway, MS, LMHC, NCC, Licensed Mental Health Counselor, MH10816