843.945.0346 Fax: 843.432.3091 [email protected]

Coastal Haven Counseling Forms

New Client Forms:

 

Adult Intake Forms

1. Group Professional Disclosure Statement Form

2. Adult Initial Clinical Assessment Form 

3. Assessment Tool (Cross Cutter) for Adult Client

4. Authorization to Release Form

5. Copay Credit Card Authorization Form (NOT NEEDED FOR MEDICAID CLIENTS)

Couples Counseling Questionnaire


​Also fill out adult forms to the left.

Couples Intake Questionnaire Form

 

Additional Forms: 

Authorization To Release Form

CHC Privacy Practices Info

FOR DOCTOR OFFICE REFERRALS: Fax In This Referral Form

TeleHealth / TeleTherapy Informed Consent Form

Interpreter Services

Self Pay Clients Good Faith Estimate of Costs

Child Client Intake Forms

1. Group Professional Disclosure Statement Form

2. Child Initial Clinical Assessment Form

3. Assessment Tool For Child (Cross Cutter) Age 6-17

4. Authorization to Release

5. Copay Credit Card Authorization Form (NOT NEEDED FOR MEDICAID CLIENTS)

CONTACT US FOR MORE INFO OR TO SCHEDULE AN APPOINTMENT

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Contact Us

Hi, I’m Haley! I’m passionate about creating a safe, non-judgmental space where you can openly share your story, uncover your hurts, and discover your strengths. Through a person-centered approach combined with Cognitive Behavioral Therapy (CBT) techniques, I offer support that’s tailored to your unique journey. My goal is to help you heal, build resilience, and empower you to live your best life.

I work with teens, adults, and families through video-based Telehealth services, making therapy accessible from the comfort of your home. I specialize in treating a variety of mental health concerns, including depression, anxiety, ADD/ADHD, Oppositional Defiant Disorder, relationship issues, self-esteem struggles, bipolar disorder, trauma, and women’s issues. Whether you’re navigating a specific challenge or looking to gain greater clarity in your life, I’m here to help you find your path toward healing and growth.

Together, we’ll explore your strengths, work through the obstacles you’re facing, and develop practical tools to enhance your well-being. I look forward to supporting you on this journey toward a brighter future.

“People are just as wonderful as sunsets if you let them be. When I look at a sunset, I don't find myself saying, "Soften the orange a bit on the right hand corner." I don't try to control a sunset. I watch with awe as it unfolds.” -Carl Rogers

I am currently a LPCA under the supervision of Sandy Quast, LPCS of Coastal Haven Counseling. 

Hi, I’m Brandi! I’m deeply passionate about helping individuals, families, and couples navigate life's challenges, with a focus on fostering growth, transparency, and positive change. My goal is to provide a safe, supportive space where you can explore your struggles, set meaningful goals, and develop the tools necessary for lasting transformation.

I specialize in working with children, adolescents, adults, families, and couples, helping each client gain a better understanding of how to apply coping skills in their everyday lives—whether at home, school, or in relationships. My approach is tailored to meet each person’s unique needs, and I utilize a variety of therapeutic techniques, including EMDR, behavioral therapy, Cognitive Behavioral Therapy (CBT), trauma-focused CBT, mindfulness, and Christian and person-centered counseling. Additionally, I am a certified SYMBIS facilitator, offering marriage counseling that equips couples with the tools to strengthen their relationships.

Whether you're dealing with life transitions, relationship struggles, or emotional challenges, I’m here to support you every step of the way as we work together to build a path toward healing, growth, and understanding.

I am currently a LPCA under the supervision of Sandy Quast, LPCS of Coastal Haven Counseling.  I look forward to working with you and supporting you on this journey as we navigate life's everyday challenges together!

Kayla O'Riley, LPCA

Hi, I’m Kayla! I specialize in working with children, teens, and adults, ages 5 to 40, to help them navigate the complexities of mental health. The journey toward healing can often feel like a long, winding road, and I truly believe that seeking counseling is one of the bravest steps someone can take. Although the road may have its share of detours and obstacles, my goal is to be there to support you through life’s greatest challenges.

I use a variety of therapeutic techniques, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Motivational Interviewing, Christian-based therapy, Play and Music Therapy, Art Therapy, and Emotionally Focused Therapy. My approach is rooted in person-centered therapy, which means I work alongside you to help you understand yourself better, develop healthy relationships, and build a lifestyle that supports your well-being.

Whether you’re working through trauma, seeking guidance in relationships, or simply wanting to create positive change in your life, I’m here to support you every step of the way. Together, we’ll explore the obstacles you’re facing and work towards a future where you can be the best version of yourself.

I received my undergraduate degree in Psychology from Coastal Carolina University and graduated from Capella University with my Master's degree in 2023. I am currently a LPCA under the supervision of Sandy Quast, LPCS of Coastal Haven Counseling. 

With a heart for helping others and a passion for making a difference, I am committed to walking alongside clients on their journey towards healing and growth.

Specializing in working with children, adolescents, and adults, I bring a unique blend of empathy and expertise to every session. Whether navigating the complexities of childhood, the challenges of adolescence, or the transitions of adulthood, I strive to provide a safe and supportive space for clients to explore their emotions, confront their obstacles, and find their way forward.

With a belief in the power of connection and the resilience of the human spirit, I am not afraid to "walk through the fire" with clients, offering unwavering support and guidance as they confront their struggles and emerge stronger on the other side. Grounded in evidence-based practices and guided by a genuine desire to see clients thrive, I am committed to helping individuals overcome their obstacles, discover their strengths, and live their best lives.

Let me join you on your journey to healing and transformation at Coastal Haven Counseling, where compassion meets expertise and every step forward is taken together.

I am currently a LPCA under the supervision of Sandy Quast, LPCS of Coastal Haven Counseling.  I look forward to working with you and supporting you on this journey as we navigate life's everyday challenges together!

Hi, I’m Gloria! With over 30 years of experience in the mental health and addiction counseling fields, I specialize in providing teletherapy services to individuals, teens, and couples. My approach combines my extensive education and hands-on experience in inpatient and outpatient mental health, addiction counseling, and clinical supervision to offer a comprehensive, empathetic approach to therapy.

Throughout my career, I’ve had the privilege of working in various settings, including intensive inpatient and outpatient care, private practice, and more. I’m dedicated to providing quality mental health and addiction treatment to those seeking help, and I strive to create a safe, supportive environment for healing and growth.

I work with clients facing a wide range of challenges, including anxiety, depression, grief, addiction, trauma, personality disorders, crisis counseling, and relationship struggles. My goal is to assist individuals and couples in making positive changes and developing healthier ways of living. Whether you’re navigating mental health concerns, working through addiction, or improving your relationships, I’m here to help you find a path toward lasting transformation and a more fulfilling life.

Let's Talk

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We're here to help, please don't hesitate to reach out.

Alyssa is a compassionate and dedicated therapist with a deep commitment to helping individuals navigate life's challenges. With extensive experience working with teens and adults, Alyssa specializes in addressing a wide range of issues, including anger management, anxiety, depression, addiction, and other mental health concerns. She combines a warm, client-centered approach with evidence-based therapeutic techniques to foster healing, growth, and self-awareness.

Utilizing Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and motivational interviewing, Alyssa works collaboratively with clients to identify and challenge harmful thought patterns, build emotional regulation skills, and create lasting behavioral changes. Her work often integrates play and art therapy techniques, providing creative outlets for self-expression and deeper insight into emotional experiences.

Alyssa believes in the power of the therapeutic relationship as a tool for change, offering a nonjudgmental, safe space where clients can explore their emotions, work through difficult experiences, and develop healthier coping strategies. Whether you are facing the struggles of adolescence, navigating the complexities of adulthood, or dealing with a specific mental health concern, Alyssa is here to support you on your journey toward a more fulfilling and balanced life.

I am a dedicated mental health therapist with over 10 years of experience helping individuals overcome personal challenges and improve their overall well-being. I believe in creating a safe and nonjudgmental space for my clients to explore their thoughts and emotions. My therapeutic approach is rooted in empathy, active listening, and evidence-based interventions.

I have extensive experience working with diverse populations and addressing a wide range of mental health issues, including anxiety, depression, trauma, couples counseling, sexual abuse, life changes, LGBTQ issues, bipolar, OCD, phobias, weight loss issues, abusive relationships, phobias, school pressure and stress and relationship difficulties.

I am committed to supporting my clients on their journey towards healing and personal growth. Please give us a call to see if I would be a good fit for your needs. I look forward to working with you!