Get startedPlease fill out the form below to get started at WAIT Counseling! Name * First Name Last Name Date of Birth * MM DD YYYY Sex * Male Female Phone Number * Primary Insurance Company * Enrollee ID // Member ID # (including letters if applicable) * Group Number * Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Would You Prefer a Male or Female Counselor? * Male Female No Preference Service * Individual Counseling Online Counseling // Teletherapy Couples Counseling Family Counseling Coaching / Mentorship Message Thank you for filling out our form! Our staff will reach out to you at their earliest convenience. You should expect a call from 810-715-9029 (within 1-2 business days) to schedule your first intake appointment. Have a blessed day!