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Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

If you think you may have a medical or mental health emergency, please call 911.

Welcome to Bevill and Associates LLC, This form provides information about the practice and privacy policies of Bevill and Associates LLC. This information is intended to help you make an informed decision about accepting services from us.

Counselor

Client Type

Client Information

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( for Text Message Reminders )


Emergency Contact

First Name
Last Name
Phone
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Email
Street Address
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( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers