Intake Form

Fill Out Our Detailed Patient Intake Form

If you are new to David C. Deal PhD & Associates, save time by filling out the patient intake form before you come to our clinic. This will help make your first visit go smoothly.

Complete the form privately in the comfort of your home and forward it to our office. We are an Ohio State Board-licensed clinic. Call us at 419-784-3393 to schedule an appointment today.
Online patient form

Download and Complete Our Patient Intake Form

Call us to schedule an appointment for our counseling services.
419-784-3393
We are an Ohio State Board-licensed counseling clinic. We provide alcohol and drug abuse counseling services to patients of 13 years and above.
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