New client intake
New Client Welcome

Complete Your Client Intake

Welcome to Erica Baker & Associates. Please fill out this brief intake form so we can prepare for your first session and match you with the right counselor.

HIPAA Secure
Reviewed within 24hrs
Personalized Matching
Insurance Accepted
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New Client Intake Form

All fields marked with * are required. Your information is kept strictly confidential.

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Personal Information

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Emergency Contact

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Insurance Information

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Preferred Counselor

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Session Preference

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Reason for Seeking Counseling

0/500 charactersThis helps us match you with the right counselor.
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Therapy & Medical History

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Consent & Agreements

What to Expect

Complete This Form

Fill out your personal details, insurance info, and counseling goals.

We Review (24hrs)

Our team reviews your intake and verifies your insurance benefits.

We Call You

We reach out to schedule your first session and answer any questions.

First Session

You receive a welcome packet with directions, forms, and what to bring.

Your Privacy Matters

All information submitted through this form is encrypted, stored securely, and protected under HIPAA. We never share your data with third parties.

HIPAA Compliant & Confidential

Questions?

If you need help completing this form or have questions about insurance, call our office.

(757) 726-2000
100 Bridge Street, Suite C, Hampton, VA
Mon–Fri: 9am – 5pm

Already a Client?

If you have already completed an intake, use our booking page to schedule your next session.

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