Debby Wines, M.Ed., LPC

The Counseling & Consulting Center

If you are ready to take the next step, and will be using insurance and/or EAP benefits, you will need to call your insurance and/or EAP company and obtain authorization for treatment prior to your first visit. Use the form below, included in the In-take Packet, provided for your convenience. Please bring your authorization number and the dates it is valid for on your first visit. For your benefit, as well as for billing purposes, obtain information concerning your deductible status and copay amount, then call and set an appointment with Debby @ 214-893-9200. She will schedule your appointment at her first available time slot.

Afterwards, click on the provided link below and PRINT OUT the New Client In-Take Packet. Please do not fill out forms on line. This form must be completed by each client in one's own handwriting. Forms should be to us at least 7 days before your first appointment. If paperwork is not received at least 7 days prior to your first appointment, your visit will be rescheduled for a later time.

Please bring your insurance card, method of payment, a photo ID and authorization number and information to your first appointment.

Please be sure to read and sign all forms insuring your awareness of our policies and procedures, including the HIPAA form.  Please save your insurance EOBs as we do not provide a summary of services or accounting.

Thank you so much.    We look forward to serving you .

INTAKE PACKET (2017).doc

(DOC — 145 KB)