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Heritage
Counseling and Wellness, PLLC
E-mail: victoriabutler@heritagecw.com
Phone: 910.240.4599 Client Portal: Link
Angier Office: 215 Fish Drive, Angier NC 27501
Dunn Office: 67 Norris Road, Dunn NC 28334
Forms
About
The following are forms that will be needed before you begin therapy. For the required forms, these will need to be filled and returned prior to (or at the time of) your first appointment.
The optional forms are for the pupose of care coordination with your other healthcare providers.
*You can view and download all forms and documents by clicking the red "PDF" icons throughout this page.
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For your convenience, we have listed instructions for ways in which you can complete and return forms.
Required Forms
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Client Intake Packet
Optional Forms
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Authorization for Release of Information
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Referral Form for Providers
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