contact us

Use the form on the right to contact us.

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3301 Neely Ave
Midland, TX, 79707
United States

(432)889-4064

licensed professional counseling for individuals, couples and families

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Patient Intake Forms

Congratulations on taking the first step towards positive change! Follow the steps below to make sure you are ready to begin counseling. I look forward to our time together.

  1. Decide on the type of counseling you will benefit from (individual, group, couples, family or workshop)
  2. "Contact Maureena Benavides" to let me know your interest and we will set up a meeting time.
  3. Fill out the Child/Adolescent or Adult Intake Forms as needed. You will need to complete one for each adult/child participating. Couples will fill out a form for each participant in couples counseling or  couples workshop . Print the forms and bring them to our first meeting or scan and email the forms to me so I can review them and we will discuss them at our first meeting. All group participants will need to await approval before joining the groups or workshops.  Once approval is given, go to Group Schedules and add the sessions to your calendar.     Other forms are provided for the convenience of the client but will be provided by the counselor to the client at the intake session.      

I'm happy you chose me to be your mental health provider and I look forward to seeing you soon. Please print and fill out the forms below and bring to your first appointment (intake meeting). 

Child/Adolescent Psychosocial

Adult Psychosocial

Couples 

Consent for Treatment

Patient Rights

Financial Policy

Payment Contract

 

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