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Simply fill out the form and we’ll be in touch soon.

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Questions or not sure what next step to take? We’re here for you! During our working hours you’ll likely be able to connect with someone on our admin team immediately.

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"*" indicates required fields

First Name*

Last Name*

Email*

Phone*

Select Preferred Location*

State of Residence?*

If not in the US select "International"

Are you or the client(s) covered by Medicaid, CHP+ or a Medicare disability plan?

* We do accept some Medicaid plans, but will need to verify benefits.

Medicaid ID Number*

Date Of Birth*

How can we help?*

How would you like to be contacted?*

Phone

Text

* You will also receive a confirmation text and email upon submitting this form.

Do you consent to receiving text messages from Cornerstone Christian Counseling?*

Yes

*By checking YES, you agree to receive text communication from our office and billing teams.

Are you a robot?

Cornerstone accepts CCHA Medicaid but does not bill other insurances. We do provide superbills for potential reimbursement.

Frequently Asked Questions (FAQ)

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