LCL MA | Clinical Services Intake (Online)

Please complete this entire form. If a question is not relevant to you, you may skip it.

You can remain anonymous by providing a false first name and last name Anonymous.
Contact Information
Consultation Info
Click Here to View other Free & Confidential LCL MA Groups you might be interested in.
Demographic Info
Required format: MM/DD/YYYY
Health Information

By submitting this form, you agree that you have read and understand the LCL "Information for New Clients", available via this link. You also understand that if you are referred to an outside provider, LCL will disclose relevant info to the provider.

If you have any questions or concerns, you are welcome to discuss these matters with an LCL clinician.