Carolina's Creative Counseling Referrals

Contact Us

To ensure your continued success, we aim to make counseling as convenient as possible.
Schedules are customized to fit each therapist-client relationship and our therapists will travel
to meet with and represent our clients.

Contact us to set up an appointment or fill out the Referral Form below and we will contact you.

Carolina’s Creative Counseling, PA
325 Matthews Mint Hill Road
Suite 105
Matthews, NC 28105
Phone: 704.332.3634
Fax: 704.332.1801

Carolina’s Creative Counseling, PA
4415 Monroe Road
Suite 200
Charlotte, NC 28205
Phone: 704.332.3634
Fax: 704.332.1801

For career opportunities, please complete our Employment Application and email it to cathy@c3families.com.

For complaints & concerns, please Click here

For information on our Grievance Policy (Download PDF) or
Grievance Policy Addendum: Using Grievances as an Advocacy Tool (Download PDF)

Please provide comments on our services so we may better serve you.

Referral Form

Referrals will be contacted within 24 hours and the C3 Clinical Assessment Team will conduct an initial assessment.

*Required Field

Date of Referral:

Referral By:

* Referral First Name:

* Referral Last Name:

* Referral Email:

* Referral Phone #:

* Potential Consumer's First Name:

* Potential Consumer's Last Name:

* School Name:

* School Grade:

SS#:

* DOB:

Gender:

Male Female

Race:

Legal Guardian's Name(s):

Relationship to consumer:

Consumer Home phone#:

Cell phone#:

Consumer's address:

Type of insurance:

Policy#:

Services are for:

Child Adolescent Adult

Requested services:

Reason for referral:

Have you received services before? (if so, where):

Presenting problem(s):

Preferences/Comments: