Four County Counseling Center - How to Make an Appointment or Refer Someone

Making an appointment for yourself, your child, or other dependent:
	1.	Call 800-552-3106 or go to one of our locations.
	2.	A receptionist will ask for the following information:
		Name
		Address
		Phone number
		Household Income
		Number of Dependents (for adults)
		Social Security Number
		Date of Birth
		Name of Insurance Company
		Phone Number of Insurance Company

Please bring your insurance card with you to the appointment.

Doctors making appointments or needing a consultation for patients:
		Call 800-552-3106, or print the following document and fax to our main office: 574-739-1414
Referring Physician Request Form