Getting Started

 
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Make an Appointment

To make your an appointment with a new clinician or your first appointment in over a year, either complete the Individual First Form or the Relationship First Form depending on what type of counseling you are interested in. If you have any questions about the forms, please call us at 901-458-6291.

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Complete Paperwork

To better serve your needs, please bring any additional applicable forms, along with your insurance card(s), to your initial appointment. These forms would be emailed to you from the CPC office after scheduling your first session.

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Arrive for Appointment

On the day of your appointment, please arrive at CPC 15 minutes early for processing. We are located at 3950 Central Avenue Memphis, TN 38111

To complete a form digitally: 1) Open the form on a computer (not a smart phone). 2) Fill out the form 3) Download the form. 4) Email to intake@cpcmemphis.net 5) Wait for a call from our intake coordinator

 

Patient Intake Forms

  • If you are interested in one on one counseling sessions, please fill out the Individual First Form.

    If you are filling this form out on behalf of minor, please list their demographic information and not your own. Testing for children ages 2-6 who have not completed kindergarten should complete the Early Childhood Clinic First Form.

    This form can be completed digitally: 1) Open the form on a computer (not a smart phone). 2) Fill out the form. 3) Download the form. 4) Email to intake@cpcmemphis.net. 5) Await a call from our intake coordinator.

    If you do not have access to a computer, you can print the form from a smart phone and submit a photo of the completed form to intake@cpcmemphis.net or come into our office to fill out a paper copy: 3950 Central Ave. Memphis, TN 38111.

  • If you are interested in counseling sessions that involve more than one person, please fill out the Relationship First Form.

    This form includes relationships and family.

    This form can be completed digitally by 1) Opening the form on a computer (not a smart phone). 2) Fill out the form. 3) download the form. 4) email to intake@cpcmemphis.net. 5) Wait for a call from our intake coordinator.

    If you do not have access to a computer, you can print the form from a smart phone and submit a photo of the completed form to intake@cpcmemphis.net or come into our office to fill it out. 3950 Central Ave. Memphis, TN 38111.

  • Por favor llene este formulario para programar una cita.

    Formulario Inicial

 

Additional forms will be sent to your email after your appointment is scheduled.

Please, bring applicable forms along with your insurance card(s), to your initial appointment.

Directions

3950 Central Ave, Memphis, TN 38111

 
 

Policies and Notification of Rights

CPC Practice PoliciesPatient Notification of Privacy Rights