Thank you for entrusting Perfectly Redeemed Counseling Services, LLC to assist with your concerns.  As your, clinical professional, I desire to provide you with the highest quality Christian Mental Health Services.

To help me best serve you, please thoroughly review, complete, and bring with you the attached documents and be sure to note any questions you have about the contents.  Thank you for completing these documents prior to your first appointment and bringing them with you.

PLEASE NOTE: For Minor Clients (under the age of 18), a Parent/Legal Guardian is required to accompany their child and remain onsite during the child’s first appointment.  Please check with me for the need of your ongoing involvement in the therapeutic process in subsequent sessions.

Current Custody Documents are required at the first session if the client is a minor with divorced parents or if the client is under the care of a guardian or Children’s Services.  This helps us to appropriately determine consent for care and access to confidential information.  Please submit the full document along with the attached forms.  PLEASE NOTE:  if Current Custody Documents are not presented at the first session, the session will need to be rescheduled.

Forms to be read, completed, and brought to the first session:

Adults - 4 Forms total

Minors - 5 Forms total



ADULT Intake Form (Adults ONLY)


Minor Intake Form (completed by minor)

Parent of Minor Intake Form (completed by parent/legal guardian)

Current Custody Documents (when applicable)

Additional items that are very important to bring to your first appointment:

  • Additional Materials: materials you feel may be helpful to me as your clinician (e.g.; reports, test results from schools, medical and/or mental health professionals, legal documents).

  • Your Treatment Goals:  How can I best serve you?  What are your hopes/goals for coming to treatment.

  • Your calendar/mobile device for scheduling appointments.

  • Your form of payment:   Cash, Credit, and Check accepted.

Should you need to cancel your session, please contact me at Perfectly Redeemed Counseling Services, LLC as soon as possible (234-334-0033) so that I may reschedule you.  A 24hr notice avoids a late cancellation fee.

Please know that I desire to be helpful to you and to make your experience at Perfectly Redeemed Counseling Services, LLC as beneficial and pleasant as possible.  I always welcome your feedback and look forward to a productive and successful therapeutic relationship. 


Tiffany M. Ingersoll, MA, LPCC-S

(234) 334-0033