Paper Registration
PLEASE PRINT, FILL OUT AND BRING WITH YOU or DOWNLOAD THE COMPUTER VERSION AND EMAIL BACK TO THE COUNSELING CENTRE

Dr. C. Steven Shaffer: M.A., M.S., D. Min., Ph.D. Executive Director -

Licensed Professional Counselor/Therapist, National Certified Counselor.

Located at 2594 Highway 34 East Suite #B Newnan, GA 30265 - 8 min. west of Peachtree City, GA and 8 min. east of Newnan, GA on Hwy. 34.

Most Major Insurances Taken  --------   Contact us at office@curecounseling.com or (770) 252-3760.

 

PLEASE PRINT, FILL OUT AND BRING WITH YOU.

 

The Life History Questionnaire is optional.

If you decide to take the time to fill it out it will save you time and money.

This Questionnaire is designed to aid your therapist in getting to know you and

your concerns very quickly so that they can begin working with you on your

concern as soon as possible.

 

Please arrive at least 30 minutes early for your first appointment.

Thank you!

Click filename below to access file

CURE_Registration_Pak_11.01.09_(Paper).pdf