New Clients

To schedule your initial session, please fill out the form below. I will be in touch within 24 hours. You can also email me at:

sara@riverbankscounseling.org

Name

First Name

Last Name

Phone

(###)

###

####

Contact

How would you like to be contacted initially?

Text

Phone Call

Birthday

YYYY

Place of Residence

I am only licensed to see clients in Nebraska.

Yes, I live in Nebraska

Insurance

Currently, I am only able to accept BCBS and Medicaid but can provide a sliding scale for private pay.

Subject

Message

How did you hear about Riverbanks Counseling?

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Riverbanks Counseling, LLC/Sara Campbell, MA, PLMHP, NCC harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Yes, I want to submit this form