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We Welcome New Clients!

Initial Form/ Referrals 

Intake referral form:  Dear clients please note that the information below is typically the information we required to be filled to be able to be seen at our office by our Licensed clinicians. Please be ready to provide the following  information to our staff.

Name*

D.O.B

Phone

Email Address*

Address (Street, City, State, Zip)*

Gender

Select an option

Race

Ethnicity

Marital Status

Type of service needed

Primary Diagnosis

List of medications, if any.

List of concerns

Schedule a Free Consultation

Valera Counseling Services, PLLC provides counseling services in a supportive and welcome environment. Contact us in our office in Winston-Salem or Greensboro, North Carolina to request a free consultation. We look forward to working with you.

Contact Information 

Valera Counseling Services, PLLC

Office Phone: (336) 261- 6440

Crisis line and emergency appointment Phone Number: (336) 908-7293


Fax: (336) 232-1436

Email: valeracounselingservices@gmail.com

Website: valeracounselingservices.com 


Visit Our Three Offices Locations:

3333 Brookview Hills Blvd Suite 205

Winston-Salem, NC. 27403

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717 Green Valley Rd.  Suite 200 

Greensboro, NC. 27408

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Service Areas

Proudly Serving Clients Worldwide

Inquiry Form/ Email us


Name*

Phone*

Email*

Message*

Checkbox List

Radio Button List

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