Contact

Name *

First

Last

Phone Number *

Email *

What Insurance do you have? *

We only accept Aetna, Capital Blue, Highmark, Tricare, and Student Resources. We do not accept secondary insurance.

What availability do you have for appts? *

Please note after school appts are limited so please list all possible times/days

In person
Telehealth
No preference

Are you utilizing Bellefonte Area School District's EAP?

If a student, what school district or college

Presenting concerns

If you are court mandated or are seeking specialized treatment for an eating disorder, addiction (substance, sex, gambling, fetishes) we do not specialize in those areas and thus can refer you to a provider to better suit your needs. In addition, Mind Over Matter Therapists do not testify in custody court related cases. If you are experiencing a recent separation or divorce and circumstances are not amicable by all parties, our group suggests a therapist that specializes in these specific matters and we would be able to provide referral recommendations.

Are you or your child displaying any type of suicidal ideation or self injurious behaviors?

No
Yes
More than 6 months ago

Have you/child ever been hospitalized for any mental health concerns and if so, when?

Are there any custody agreements in place? If shared custody, both parents need to consent to counseling (if so we will need a copy)

Were you referred by someone?

Name

Send A Message

Mind Over Matter Professional Counseling Services

111 South Spring Street • Bellefonte, PA 16823
814-933-5335

Send A Message

Mind Over Matter Professional Counseling Services

111 South Spring Street • Bellefonte, PA 16823 814-933-5335

111 South Spring Street • Bellefonte, PA 16823
814-933-5335