Intake Form Due to a high volume of requests, we currently have a limited capacity for counseling. We will do our best to accommodate you; if we are unable, we will provide you with some outside counseling options.Name* First Last Email* Phone*Home Address*Currently, we are only able to see people within a 1.5 hour radius of our Glenside, PA office. If you live outside of that radius, please visit our Counselor Information Request form to get information on counselors who are in your area. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What days and times are you regularly available for appointments?*Would you prefer an appointment with a single or married male or female? If you do not have a preference please answer "No Preference." (Check all that apply.)* Single Female Married Female Single Male Married Male No Preference Are you applying for counseling through the Presbyterian Church in America Cherish or ServantCare program?*NoYes: ServantCare (Available to PCA employees of participating churches)Yes: Cherish (Available to PCA pastor's wives)Have you counseled previously at CCEF?*YesNoWho was your previous CCEF counselor?*At this time, the CCEF main office does not work with third-party insurers nor provide the diagnostic codes needed for reimbursement. All counseling charges are due prior to each appointment. For more information, click here.CommentsThis field is for validation purposes and should be left unchanged.
