Counselors Link Home PageCounselors Link ServicesCounselors Link Keys ProgramCounselors Link Employee Assistance ProgramCounselors Link LibraryCounselors Link BookstoreAbout Counselors Link

NOTE:  This is a Double-Hammer Computer Services DEMO site, and is no longer active!
Please view with that in mind... information, forms and links may no longer be valid.
Copyrights may continue to be held by the original owners of the site.

Previously Registered Client
Service Request and Log-In Form

Please fill in the following information when logging in...

 

Username and Password
(What we previously assigned you when you registered with us)
Fields marked  * *  are REQUIRED information.
Username: * *
Password: * *
E-Mail Address: * *


Payment Information:

* * (Required Information)
Card Type:
Card Number:
Expiration Date:
Name on Card:


Select the Counselor Type you are interested in...
Then the Type of Service...

(Your Credit Card will be charged based on what you select below)
 
topic.gif (538 bytes)

service.gif (613 bytes)
 

Desired Appt. Date: * *
First Choice Time: * *    (Little Rock, AR  Time)
Second Choice Time: * *    (Little Rock, AR  Time)

THANK YOU... for making an appointment with Counselors Link!

We will E-mail you back shortly with your Confirmation Number for this Transaction.  Our E-mail will also Confirm your Appointment Date and Time.

If you are requesting our "Need Help NOW" Personal Chat Service,  our E-mail will also give you "when and where" instructions for the chat.


Please review your information listed above for accuracy, then click "Submit" to send this form to us.

    



NOTE:  This is a Double-Hammer Computer Services DEMO site, and is no longer active!
Please view with that in mind... information, forms and links may no longer be valid.
Copyrights may continue to be held by the original owners of the site.

 
 

Copyright 1999 Counselors Link.com
Designed & maintained by Double-Hammer Computer Services
 
Hit Counter
This page last updated 09/04/11