top of page

Patient and Referral Forms

Patient Self-Referral

We value your outreach for counseling at Credence Counseling Services and look forward to supporting your personal growth journey. Please feel free to take a moment to complete this brief self-referral form so our staff can determine how to best serve your unique growth and counseling needs. Referral forms may be returned to our primary email address at: credencereception@gmail.com 

​

*Notice: We apologize for any inconvenience, but this form is currently being reviewed and edited. We will have it available as soon as we can. 

Professional Referral
Please feel free to send referrals and referral forms back to our HIPAA compliant secure fax line at (970) 225-5490.

bottom of page