Make An Appointment

Questions? Ask Martha.

Call: 816.892.0803 or Email:
Martha@ChildersCounselingService.com
Fax: 888.965.4024

Make an Appointment Today.

Martha Childers, EdS, LPC

New Clients

After we have made an appointment, you will receive an email with intake forms and directions to my office. Please print and complete the intake forms and bring them with you to the first session.

If you do not receive the email or if you have any questions or concerns, please contact me at 816.892.0803 or via email at Martha@ChildersCounselingService.com.

Counseling sessions are 45 minutes.

There is a 24 hour cancellation policy. If you need to cancel or reschedule a session, please do so at least 24 hours before your scheduled time. You will be charged the full fee for any missed sessions not cancelled more than 24 hours before the session.

EAPs, Insurance and other Programs

Martha accepts Health Savings Account (HSA) and out-of-network insurance, including Blue Cross Blue Shield of Kansas City (deductibles may apply).

Martha is a provider for the following Employee Assistance Plans. Ask your employer for a referral.

• New Directions EAP
• Right Solution Counseling Services
• Missouri Lawyers’ Assistance Program
• Burrell Behavioral Health
• E4 Health
• APS Healthcare EAP
• Cleveland Clinic Lifestyle EAP
• Deer Oaks
• INOVA
• Network Advantage Services
• Vital Work Life

If your employer’s EAP is not listed, and you would like to see Martha through your EAP, ask them to add her as a provider.

Sliding Fee Scale

Sliding Scale Inquiry

Please use this form to begin the application process. For couples, each person needs to complete his or her own form. Each person completing the application below will need to bring supporting financial documents to the first session.

Comments or questions are welcome.

* indicates required field

First Name:*

Last Name:*

Email:*

Referral Source:

Type of Therapy:

Couple Therapy
Individual Counseling

Dependents:*

1 (just myself)
2 (myself and one person with no income)
3 (myself and two others with no income)
4 (myself and three others with no income)
> than 4

Estimated Annual Income:*

I have no income to document.
I make between $11,490 and $14,363 per year.
I make between $14,363 and $20,107 per year.
I make between $20,107 and $22,980 per year.
I make between $22,980 and $31,597 per year.
I make more than $31,597 per year.
I am unemployed, and receive a check (please estimate annual income in the message box below).
I am unemployed but do not receive unemployment.

Information I Should Know:

CAPTCHA Code:*