Mental Health Counseling Ballantyne Charlotte NC ONE:12 Counseling

We are looking forward to the opportunity to help you along your journey of personal growth.

So that we can get to know each and every individual client as much as possible, we collect some basic personal information up front to help us get started.  This process also helps us ensure that we have your up-to-date contact information on file.

One:12 Counseling’s New Client Intake Forms are available below for you to complete in advance of your first appointment.


Please click on the appropriate form from the list below.  You will need Microsoft Word to view the file.

After downloading the file, you may type your responses directly into the document.  Please print and sign it and bring it with you to your first appointment.

If you have any questions, or to schedule your first appointment, contact us via phone (704) 626-6550 or email

We are looking forward to meeting you soon!