Forms
Download Professional Disclosures as well as Intake and other Forms, below.Find LifeCare's Forms and Disclosures
Provider Consent forms must be signed prior to your first appointment. Contact the office at info@lifecarecc.com or call 919-851-1527 to receive access to have a form sent securely via email.
Also, choose the appropriate Intake Forms you need to complete and bring to your first appointment.
If you are not able to download the forms please arrive 15 minutes early to complete them or call our office at 919-851-1527. Please also read our Notice of Privacy Practice below.
LifeCare's Professional Disclosures
Adam Cheyunski (RN, PMHNP)
Christian Psychiatrist
Alyssa Weaver (MA, LMFT)
Christian Counselor
Amy Perry (MSW, LCSWA)
Christian Counselor
April Miller (MACC, LCMHCS)
Christian Counselor
Ashley Poole (MA, LCMHCA)
Christian Counselor
Bill Venable (MA, MDiv, LCMHCS)
Christian Counselor
Cameron Garcia, MA, LCMHCA
Christian Counselor
Carolyn Ballantine (MD)
Christian Psychiatrist
Catherine Doster (MA, LCMHCA)
Christian Counselor
Catherine Saunders (MA, LCMHC)
Christian Counselor
Christina Richardson (MA, LMFT)
Christian Counselor
Cindy Simpson (MA, LCMHCA)
Christian Counselor
Daniel “Dan” Meyring (PA, C)
Christian Psychiatric Provider
Dedrick Gaddy (MSW, LCSWA)
Christian Counselor
Diane Myers (MA, LCMHC)
Christian Counselor
Ebonee Grissett (MA, LMFTA)
Christian Counselor
Emily Freeman (MSW, LCSW)
Christian Counselor
Emily Hartung (PhD, LCMHC)
Christian Counselor
Hannah Smith, Intern
Christian Intern Counselor
Jeremy George (MA, LCMHCS)
Christian Counselor
Jeremy Hudson (MA, LCMHCA)
Christian Counselor
Jessica Jones (MSW, LCSW)
Christian Counselor
Karina Morato (MA, LCMHCA)
Christian Counselor
Kathleen Hamby (MS, LMFT)
Christian Counselor
Katie Vermette (MA, LCMHC)
Christian Counselor
Katy Moyer (MA, LCMHC)
Christian Counselor
Korey Morgan (MA, LCMHCA)
Christian Counselor
Laura McEwen (MA, LCMHC)
Christian Counselor
Mark Harol (MS, LCMHC, NCC)
Christian Counselor
Mary Paul Gomez (MA, LCMHCA)
Christian Counselor
Renee Landtroop (MA, NCC, LCMHCA)
Christian Counselor
Ryan Chriscoe (MA, NCC, LCMHCA)
Christian Counselor
Ryan Murdoch (MA, LCMHC)
Christian Counselor
Sarah Jones (MA, LCMHCA, NCC)
Christian Counselor
Steven Price (MA, LCMHC)
Christian Counselor
Victoria Welch (MSW, LCSW)
Christian Counselor