HEALING & EDUCATION CENTER (VOP, INC.)  

Transforming Lives: Body, Soul & Spirit 

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FOR CHRISTIAN CLINICAL COUNSELING 

EMAIL THE INFORMATION BELOW TO:  vopcenter@aol.com

   

CLIENT INFORMATION (*Information Required)

First Name *

 

Middle Initial (optional}

 

Last Name *

 

Daytime Phone *

 

Is this your first counceling session? *Yes  No

 

Appointment Information

Date * 

Time *     Morning        Afternoon        Evening

 

LOCATION PREFERENCE

Virtual   

Phone

No Preference

 

Please describe the reason for your appointment *