Video Counseling
Video Counseling Intake Form
All Fields Required
Your name:
Email:
Street
Address:
City:
Zip Code:
State:
Phone:
First & Last Name Of Emergency Contact:
Phone Number of Emergency Contact:
Best Time
To Call You:
What Are Your Presenting Problem or Focus For Counseling?
What Are Your Previous Counseling Experiences?
Are You Currently Having Any Symptoms And How Severe Would You
Describe Them?
How Often Would You Like To Schedule Your Video Counseling
Sessions? Once A Week? Twice A Month?
Are You Looking For Day Time or Evening Time Sessions? Ideally What
Day or Days Would Match Your Schedule
Does Your Computer Have a Webcam and Do You Have a Headset? If Not
Would You be Willing to Purchase the Equipment You Need In Order to
Conduct a Video Counseling Session?
Thank You For Your Therapy Request. A Clinical Supervisor Will Contact
You Via Email or Phone To Schedule Your Video Session With You And
Answer Any Additional Questions.
Counseling Wellness Therapy
The Place To Get The Help You Need

Video Counseling utilizes video conferencing technologies to provide face-to-face counseling via the
use of webcam and your computer. You can communicate to our counselor from anywhere in the world
utilizing state of the art technology. The fee for a video session is $140.00 per session.

There are several advantages to video counseling. You are able to connect with a counselor who offers
the specialization that meets your needs, in the comfort of your own home or office. There is the
opportunity to see facial expressions which are not available with traditional phone counseling.

There are some disadvantages to video counseling such as the quality of the video display, as well as
limits upon the level of eye contact which is experienced in traditional face-to-face counseling sessions.

Several different Webcams are available on the market, including those that come with your computer.
Some provide a better picture than others. Also, depending upon Webcam placement you may not be
able to attain consistent eye contact with your counselor.

Video Counseling from our site is provided through various video conferencing technologies.  It is
easier than you think. Our therapists use either CounselingWellnessOnline Video Room or Skype.  To
sign on to your video counseling session you must first call the clinical coordinator to schedule your
session, and prepay.  Video Counseling is not on demand, as with instant session. You must schedule
a meeting time and set up your computer prior to your session.  You then decide which technolog is
right for you and the clinician.  To download skype click here.