Your First Visit

To ensure that your first visit with Old Towne Counseling Services is stress-free, please take time to find and fill out the appropriate forms listed below. If you need assistance, please call us and we will be happy to help you.

To prepare for your first visit with a therapist, please:

Arrive 20 minutes early to your appointment. This allows time for our check in process.

 

 Complete the appropriate forms below and bring them to your first appointment. 


Please bring your insurance card and a Government-issued form of identification, such as a birth certificate, drivers license, or a DMV identification card.

 

If you are seeing a therapist, please print and complete these forms:

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Patient Record Form

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Physician Care Communication Form

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Coinsurance Policy

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Credit Card on file

If you are using our telehealth option, please print and complete these forms:

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Telehealth Consent Form

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Telehealth Information Form

If you are meeting with Olivia Reinchenbacker, please print and complete these forms:

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Consent Form

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Patient Record Form

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Olivia Self-Pay Agreement

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Olivia Cancellation Policy

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Credit Card on file

If you are meeting with Diana Boutté, please print and complete these forms:

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Consent Form

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Patient Record Form

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Diana Self Pay Agreement

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Diana Cancellation Policy

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Credit Card on file

Old Towne Counseling Services, LLC. 
7489 Right Flank Road 
Mechanicsville, VA  23116
804-398-8401

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