Feelings Wheel

Download a pdf of the Feelings Wheel

CONTACT FORM. Taking new clients with intake appointments in 2 weeks or less!

New Clients please check all current available times/locations combinations that you are able to get services at: *

COLUMBUS Ohio Office IN-PERSON every-other MON & TUE 7AM-12PM
HOMEWORTH/ALLIANCE Ohio Office IN-PERSON MON 7AM-9PM (Homeworth is 2.5 hours NE from Columbus) with our patner practice
ONLINE VIDEO TUE 7AM-12PM EST (for Ohio residents only)
COLUMBUS Ohio Office IN-PERSON every-other SAT 8AM-12PM
Online Coaching Sessions- Various Days/Times Available (US residents only)
Need Other Info- Contacting CAASS for other information (e.g., client records, consultation, speaking requests)/anything other than becoming new client

FAST SCHEDULING: 1st SESSIONS 1-2 WEEKS FROM CLIENT CONTACT. Above time/location combos are the only current availability for new clients. If you do not see an office/time combination you can do, check back in a month or two to see if there are more/different availability. Please DO NOT FILL OUT this form if you can't do the times above, we do not keep a waiting list.

What CAASS service are you interested in? *

How will you pay for services/what health insurance company do you have? CAASS offers a discounted self-pay rate. *

Can only accept new Columbus and Online clients who are self pay or using OhioHEALTHY or Medical Mutual insurance. Our clinical partners at the Homeworth Office accept MedMuc and OHIOHealth along with additional insurances (marked with *) and have a lower self-pay rate.

Name of Perspective Client or Person Wanting Info *

First

Last

Email *

We normally contact clients via email. If you would like us to call or text you, make sure you let us know in the message section below.

What do you need/what challenges would you like help with? *

PLEASE don't send sensitive personal or clinical information via this form.

Phone/Text number *

If you would like us to call or text you, make sure you let us know in the message section above.

Age of prospective client *

City and state that client lives in

Name of Person Filling Out This Form (only if different from above)

First

Last

Anyone is welcome to use this form to make inquires about CAASS services for themselves or anyone else but be aware that if the perspective new client is a legal adult (age 18+) and not under the legal guardianship of person filling out form, this adult perspective client needs to contact CAASS directly to make an appointment and needs to sign all paperwork themselves. PARENTS OF LEGAL ADULTS CANNOT MAKE APPOINTMENTS FOR ADULT CHILDREN unless adult child has authorized CAASS to do so. If the perspective client is a minor (age 12-17) the parent or legal guardian should fill out form. Legal documentation is required to establish legal guardianship. If minor's parents are divorced, legal documentation needs to be provided to show parent making appointment has the right to make health care decisions for minor.

What is the main way you found out about CAASS?

Word of Mouth/Personal Referral
CAASS website
Web Search
Psychology Today
Another Mental/Medical Health Practioner
Read an article/YouTube Video
Other
Not Sure/Prefer Not to Answer

Comment

Current Clients

If you need to contact your provider please contact them though the client portal (best way) or call or email them directly.

Office Locations

Online Coaching Services
Columbus, Ohio
Homeworth, Ohio
Can refer clients to partner practice in New Albany, Ohio.