Contact us.

emilykohls@eclipse-counseling.com
910-218-1603 (phone)
910-889-0736 (fax)

700 Military Cutoff Road, Suite 108B
Wilmington, NC 28405

Name

First Name

Last Name

Phone

By entering your phone number, you agree to receive SMS messages from Eclipse Counseling (information requests, appointment scheduling, account notifications, etc). Message frequency varies. Message and data rates may apply. for help, reply HELP or email emilykohls@eclipse-counseling.com. You can opt out at any time by replying STOP. Our terms and conditions and privacy policy are below.

(###)

###

####

Message

Please include a brief description of the primary struggles you're seeking therapeutic support for. Please refrain from including sensitive details that infringe on your privacy.

Insurance Type

Blue Cross Blue Shield

Blue Value

Aetna (including State Health Plan)

United Health Care

Out of Network

Self Pay (including potential for income-based Sliding Scale pricing)

Terms and Conditions

I acknowledge the limits to digital privacy.

I acknowledge the messaging terms and conditions and consent to the messaging privacy policy.

Limits to Digital Privacy:
Please note that email and other electronic communications may not be fully secure. While I take care to protect your information, I cannot guarantee the confidentiality of information shared through non-HIPAA-compliant means. This contact form is intended for general inquiries and to help determine whether we may be a good fit to work together. For your privacy, please avoid including sensitive or detailed clinical information here - we will have a secure space to talk about those concerns once we connect for your consultation call.

Mobile SMS Messaging Privacy Policy: Information collected: We may collect information, such as name, phone number, and email address. Use of information collected: We may use the information we collect to perform the services requested including billing, customer service, appointment reminders and other administrative requests. Sharing of information collected: We may share information we collect with payment processors, legal authorities, partners so that these service providers can perform their normal duties. We do not share, sell, rent, or trade any information provided with third parties for promotional purposes. As a current or prospective customer, you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help. You understand that the messaging frequency may vary. Messaging & data rates may apply. Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail.

Contact us.

Location

Contact