New and Returning Clients should request an appointment by completing the form below:
Anyone wanting an intake appointment must complete this form in order to be scheduled.
This form requests your insurance information, which you will need to provide, if you are choosing to use insurance.
Please note that our forms and website are private and secure.
Please do not fill this out in cases of emergency. If you are experiencing a crisis, please call or text 988, call 911, or visit your local emergency room.
For minor clients, where two-parent consent will be required please scroll to the bottom of the page to review information about two-parent consent in addition to completing this intake request form. Thank you.
Are you a parent registering for a new or returning client intake for your child? If the minor child’s parents have not/never been together or are no longer together (separated/separating, divorced), two parent consent will be required by having both parties complete the Policies Packet with hand signatures by each parent (digital signatures will not be accepted). Please download the policies for your review, completion, and hand signatures on each portion of the document by both parents. You may send the completed forms to info@bloomingmindscounseling or fax to 931-386-6301. Once we have received the hand signed document from each parent, we can proceed with scheduling an intake appointment, dependent on clinician availability, at that time. Please make sure that you have also completed the intake request form above so that we have information associated with the consent form or we will not be able to proceed with any communications or scheduling after receiving the policies form. Thank you.