Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

REQUIRED FORMS: 1. Informed Consent for Therapy Participation, Practice Policies, & Procedures; 2. Notice of Privacy Practices; 3. Biopsychosocial for Adults or Child/Adol. Admissions & History Form (complete 1 form for the identified client). PARENTS REGISTERING A MINOR: refer to the identified “client” as your child/teen when reading & completing forms.

Client Type

Client Information

Legal First Name / Middle Initial

Last Name

Preferred First Name ( optional )

Date of Birth
( MM-DD-YYYY )

Pronouns ( optional )

Gender ( optional )

Street Address

Street Address 2

City

State

ZIP Code

Cell Phone ( for Text Message Reminders )
Preferred Contact #

Home Phone
Preferred Contact #

Bill To Contact

Same as above Different

First Name or Organization Name / Middle Initial

Last Name

Street Address

Street Address 2

City

State

ZIP Code

Phone

Emergency Contact

First Name

Last Name

Phone

Mobile

Relation

Street Address

City

State

ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )

Confirm Email

Username
Between 8 and 40 letters and numbers

Local Time / Timezone

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )

Question #1

Answer

Question #2

Answer

( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Creative Insights Counseling - Secure Client Area

Register

Client Type

Client Information

Bill To Contact

Emergency Contact

Log in Details

Challenge Questions