Service Request Form

Service Request Form

Please complete this Service Request Form and you will be contacted about scheduling an Initial Service Consultation appointment, which is required prior to scheduling Counseling or Consultation Services.
  • Client Information

    Please complete the following section with information about the person for whom services are being sought.
  • *NOTE: In order to access services, you must be a resident of Oklahoma.
  • Services Requested

    *NOTE: Calm Waters is only able to serve those who are experiencing grief/loss related to one of the above.
    *Note: Individual counseling services are available for ages 6+. Children ages 5 years and under will be served through family sessions involving at least one parent/caregiver.
  • Payment

  • Scheduling