Intake FormCCCadmin2023-12-27T18:00:26+00:00 Intake Form Please enable JavaScript in your browser to complete this form.Name *FirstLastPronounsShe, Her, HersShe, Her, HersHe, Him, HisThey, Them, TheirsZe, Hir, HirsNo PronounsNo PreferenceNot ListedEmail *Phone Number *Location of Choice *Wexford (with optional Telehealth appointments)Squirrel Hill (with optional Telehealth appointments)Counselor of Choice in Squirrel Hill *Director's recommendationCatia Fath, NCC, LPCJennifer Black, LPCJennifer Matesa, LCSW, MFAKatyana Gradler, LCSWHayley Sweitzer, LCSWAllyse Rindone, LPCKelly Horvath, MSWIf no choice is made, the director will make a recommendation.Counselor of Choice in Wexford *Director's RecommendationCatia Fath, NCC, LPCNicole Metger, LPCJessica Peluso, LPCBarbara Thompson, LPCRachael Johnston, LPCAmanda Buchheit, LPCIf no choice is made, director will make a recommendation.Briefly describe why you are seeking help. *Insurance (We do not accept Medicare or Medicaid.) *AetnaBlue Cross/Blue ShieldEvernorth (Cigna)HighmarkUnited HealthcareUPMC CommercialOtherSelf PayFront of Insurance Card Click or drag a file to this area to upload. To help with coverage determination, please upload a picture of the front of your insurance card.Back of Insurance Card Click or drag a file to this area to upload. To help with coverage determination, please upload a picture of the back of your insurance card.MessageSubmit More Questions? Call (412) 229-7353 Email Creating Connections Counseling
