Online Intake Forms

Client Intake Form

After Your First Initial Call with Cornerstone of Hope and Before Your First Appointment:

Thank you for contacting Cornerstone of Hope Lima! Prior to your first scheduled appointment you will need to fill out our intake form located below. For questions regarding the intake form, please contact our office at 419-581-9138.

Click For Child Intake Form Online

This form is to be filled out by parent/guardian of the child/teen if under the age of 18. The form is to be filled out using child/teen details. 

 

Click For Adult Intake Form Online

Please fill this form out if you're over the age of 18. If coming for couples counseling, each individual will need to fill out a separate form.

 

2963 Blue Jacket Court | Lima, Ohio 45806

p. 419.581.9138

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