ATHENS CENTER FOR COUNSELING AND PLAY THERAPY
Home
About Us
Leslie
Leigh Ellen
Chelsea
Rebecca
Allia Siler
Robert Lomax, LCSW
Heather Hastie
Parent Coaching
Athens Therapy Co-op
Contact
FAQs
Interns
Home
About Us
Leslie
Leigh Ellen
Chelsea
Rebecca
Allia Siler
Robert Lomax, LCSW
Heather Hastie
Parent Coaching
Athens Therapy Co-op
Contact
FAQs
Interns
We do not have a front office staff. If you'd like to make an appointment with a specific therapist, please click on their name under the About Us tab to contact them directly. If you have no preference, or if you are interested in more than one therapist listed, please fill out the following form and someone will get back with you. Each of our therapists has their own areas of expertise. The more information you can share with us the better we can match you with a therapist best suited for your needs.
Please note: if you fill out the contact form here and list multiple therapists in the preferences, all those therapists will be notified, and someone will be in touch with you to let you know their availability.
If you fill out multiple forms individually, this can result in delays.
*
Indicates required field
Name:
*
Email
*
Phone Number
*
Name of client (if different)
*
Additional client needs or parent concerns:
*
Client Date of Birth
*
If the client attends school, what school do they attend?
*
If the client is a minor, do you share legal custody with anyone else?
*
Yes
No
Client is not a minor
If the client is a minor, do you share physical custody with anyone else?
*
Yes
No
Client is not a minor
Multi-household Acknowledgment: We may ask you to provide contact information and legal documentation for any parents/guardians with whom you share legal or physical custody. We will speak to the primary parent at intake about if it is in the child's best interest to reach out to the other parents/guardians.
*
Agree
Disagree
Not applicable
Do you have a preference for a clinician?
*
Leslie
Leigh Ellen
Chelsea
Bethany
Rebecca
Allia Siler
Intern
No preference
Insurance carrier, if any
*
Are you open to private pay?
*
Yes, open to paying out of pocket
No, would like to use insurance.
Do your concerns include any of the following? Select all that apply.
*
ADHD
Adoption
Anxiety
Attachment
Behavior
Depression
Educational
Family changes
LGBTQ+
Parenting concerns
Prefer not to answer at this time
Trauma
Unsure
Other
Do you have a preference for session location?
*
Telehealth/virtual only
In-person only
Either
If a therapist is not available, would you like to be on a mailing list to be notified if a spot opens up? From time to time we hire new therapists or we have a therapist who has openings.
*
Yes
No
Submit
Athens Center for Counseling and Play Therapy
485 Huntington Road #197
Athens GA 30606
phone 706-363-3352
fax 706-363-3352 (yes, it's the same)
