Make An Appointment

If you are interested in scheduling a counseling appointment with New Creation Counseling Center, please complete the form below, then click "Send Form" when you are finished. An Intake Specialist will get back to you as soon as possible to schedule your first appointment.

If you just have a general question for us, call us at 937-667-4678 or visit our Contact page.

Intake Form - New Creation Counseling Center

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Client Name: *

Date of Birth *

Health Insurance? If yes, Coverage through:

E-mail address: *

Address (Including Zip Code) *

Primary Phone Number *

Secondary Phone Number

Marital Status

Parent/Guardian Name (For Minors Only)

May we mail paperwork to your address listed above?

May we leave a message on your primary phone number listed above?

Concerns leading you to seek counseling *

How did you hear about NCCC (Organization or Person's Name)

Which Campus Fits Your Needs Best (Tipp City, Centerville, East Dayton, or Piqua)

What Day of the Week Fits Your Schedule Best? (Please Note Weekend Appointments are Very Limited) *

What Time of the Day Fits Your Schedule Best? (Please Note Evening Hours are Limited) *

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New Creation Counseling Center

937-667-4678

Tipp City

Main Campus

7695 S. Co. Rd. 25A

Tipp City, OH 45371

Hours & Directions

Centerville

Fairhaven Church

637 E. Whipp Rd.

Centerville, OH 45459

Hours & Directions

Dayton

New Hope Church

530 Xenia Ave

Dayton, OH 45410

Hours & Directions

Piqua

Piqua Compassion Network

531 W. Ash St.

Piqua, OH 45356

Hours & Directions

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