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Online Registration

To better assist you, please include as much information as possible. Fields marked with a asterisk (*) are required for completion. If you do not know your insurance numbers, you may skip those entries for now. A copy of your insurance card will be required at intake.

Please note that we will not obtain an explanation of benefits from your insurance provider(s) until after your intake session. It is strongly recommended that you call the number provided on your insurance card to request information about your coverage (including copay/co-insurance rates, deductible, out-of-pocket maximum payment, and session limits, if any).

At this time, we do not provide services out of network. Please check the front page for a list of insurances we can accept.

If you have any questions, please include them in the "Description of Concerns" field, or contact the office by phone or email using the contact information listed above. Due to registration volume, response time may vary. Please allow at least 48 hours before further inquiry.

Thank you for your interest in our services. Please allow up to 48 hours for us to process your information and to contact you for follow-up.

Peace of Mind Counseling, Consulting, and Supervision LLC

"Humans helping humans find peace of mind."

4025 Holt Rd Ste 205 Holt, MI 48842 • (517) 881-7231 •

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