Intake Information Form

This form is used to collect basic information about you and your insurance provider.

Step 1 of 2

  • Deirdre F. Haynes, Ed.S, NBCT, NCC, LPCS, GCDF
    1030 St. Andrews Road, Suite A-1 Columbia, SC 29210
    Phone: 803-790-2025   Fax: 803-790-7010
    Licensed Professional Counselor (#5425), State of South Carolina

  • Intake Information:


Hypnosis services are now available via phone or video!