Counseling & Med Management Contact

creasman counseling, pllc

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Counseling & Medication Management Request

If you are unsure if you would like medication, but would like a consultation, please complete this form.

* Indicates required field

My name is...(first name, last initial *

First

Last

My insurance is *

Please note that we are not in network with Blue Value, Blue Home, or Blue Local plans.

The first four characters of my insurance member ID are *

If you are not using insurance, please enter "NA."

I would like to meet... *

In person Virtually (video telehealth) Either

For counseling, I'd like to meet with... *

For medication management, I'd like to meet with... *

I'm seeking help with... *

Depression Anxiety Trauma Career Relationships Body Image/Self-esteem Substance use concerns (myself or family) Identity (race, gender, ethnicity, sexuality Parenting Panic attacks Perinatal mental health concerns My child or adolescent Something else

Check all that apply.

If you checked "something else," please describe. *

Have you ever been diagnosed with or suspect that you have ADHD? *

Yes No

Please contact me by... *

Phone Email

Please enter your phone number or email *

Is there anything else you would like us to know or questions you have? *

What county in North Carolina are you located in? *

What is your preferred language? *

English Spanish Turkish

How did you hear about us? *

Submit

Mental Wellness for All

raleigh

715 W Morgan St. Raleigh NC 27603

Durham

2009 Chapel Hill Rd.
Durham NC 27707

NEw Bern

606-B Pine Tree Dr. New Bern NC 28562

Phone/fax

join our team

(p) 919 977 0087
(f) 919 890 0852

Home
About Us
Services
Resources
Podcast
Client Portal
Contact