OFFICE: 828-257-2759

BILL FROST, MA, LPC
125 TACOMA CIRCLE
ASHEVILLE, NC 28801
828-779-9975
EMAIL BILL

ANNA FROST, MA, MA, LPC
125 TACOMA CIRCLE
ASHEVILLE, NC 28801
828-318-6283
EMAIL ANNA


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SIGN IN

Whether you prefer therapy by phone, webcam or email, we ask you to provide some basic information which will help us begin our work together.

To begin online counseling, read the TERMS OF SERVICE, submit this SIGN IN page and then contact us by phone or email. Feel free to call or email if you have a question or concern.

Personal Data

First Name:
Last Name:
Date of Birth:
(We currently take clients over 18 for distance work)
Gender:
Marital Status:
Occupation:
Employment:
Home Address:
City:
State:
Postal Code:
Country:
Phone Number:
Emergency Phone Number:
Email Address:
Confirm Email Address:


Medical/Psychiatric Information
Are you presently under the care of a psychiatrist or other physician for a mental health concern? Yes No
If so, please indicate your main reason for care:
If you are currently taking medication, please list and include dosage along and indicate the reason/purpose for taking this prescription:

Counseling Information
Are you presently undertaking any other form of counseling or psychotherapy?
Yes No
What brings you to want to begin therapeutic work at this time?
Is there anything you would like for us to know prior to beginning our work together?


I understand and agree to abide by the TERMS OF SERVICE.


After submitting this SIGN IN information, contact us by phone or email to schedule your appointment time.