Emily H. Newberry, LPC, CPCS, CCH
Cell: 478-787-3056 ~ Email: [email protected]
Counseling Registration Form
Counseling Registration Form
PLEASE NOTE THAT IF YOU ARE COMPLETING THIS FORM ON A COMPUTER WITH A STRONG FIREWALL, YOUR RESPONSES MAY NOT GO THROUGH.
PLEASE USE A PERSONAL COMPUTER OR MOBILE DEVICE IF POSSIBLE.
Once this information is received, you will receive a
follow up email within 24 business hours.
Please check your spam folder or call if you do not receive a response.
PLEASE NOTE THAT IF YOU ARE COMPLETING THIS FORM ON A COMPUTER WITH A STRONG FIREWALL, YOUR RESPONSES MAY NOT GO THROUGH.
PLEASE USE A PERSONAL COMPUTER OR MOBILE DEVICE IF POSSIBLE.
Once this information is received, you will receive a
follow up email within 24 business hours.
Please check your spam folder or call if you do not receive a response.