Referral Form for Providers Only

Every voice deserves to be heard—and your healing matters.

Thank you for taking this important step toward your emotional wellness. At Everlasting Wellness LLC, we are committed to creating a safe, supportive space where you feel seen, heard, and cared for—no matter what season of life you’re in.

📋 Please complete the form below to request an appointment.
Once submitted, you will receive intake paperwork. To honor your time and hold your spot, we kindly ask that all paperwork be completed within 24 hours.

🔔 If you do not receive a response from our team within 2 business days, your request may not have been received. Please reach out to us directly so we can assist you.

We are deeply committed to matching you with the right clinician and will do our best to accommodate your preferences.

💬 Have questions or need assistance?
You are always welcome to contact us at 484-706-9465 or care@everlastingwellnesscounseling.com.

Because at Everlasting Wellness, you don’t have to navigate this alone.

We don’t ask you to be okay. We ask how we can hold space while you’re not.