Fees for Initial Private Office or Phone Consultation Now receive a FREE Relax-Away Teletherapy Session Anywhere after your initial consultation! - The Doctor is on the Phone :The Doctor is on the Phone

(334)440-6174

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Register for an Initial Consultation in the Comfort of Your Home

Let’s get started with registration today to receive effective and lasting results with Tele-Counseling.

The purpose of the consultation is to determine whether we can establish a relationship to help you achieve your goals.
We will discuss all fees, procedures and service guarantees so you make an informed decision.
Your welcome to have a significant other person to sit in with you during this initial consultation.

Now choose option 1 or 2 to reserve an appointment for your initial one-hour consultation.

You will participate in a private tele-counseling interview and assessment with Dr. Clinton Smith. A therapy plan will be presented to resolve your lifestyle issue in the shortest period of time.

Complete the appropriate form below. You must make a $35 payment with a debit of credit card to reserve your appointment.

General Registration Form

Anxiety Control &
Pain Relief

Weight Loss Registration Form

Stop Cravings &
Emotional Eating

Stop Smoking Registration Form

No Weight Gain &
No Withdrawal

We will contact you to set an appointment once your completed form has been received. During the consultation, affordable programs and payment options will be offered.

Click Here to Prepare for Mental Relaxation Therapy at Home or at Your Office

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Use Tele-Counseling at Home or for Workplace Wellness

WEIGHT LOSS

Learn More

PAIN & MIGRAINE

Learn More

STOP SMOKING

Learn More

ANXIETY & DEPRESSION

Learn More

ALCOHOL & DRUGS

Learn More

GAMBLING

Learn More

Stop Smoking Registration

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
Card Details
Cardholder Name

WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

Private Weight Loss

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
Card Details
Cardholder Name

WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

Special Offer: Weight Loss Recordings (1) $19.95 (2) $35.00

Click Here to Order

Gambling Registration

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Alcohol & Drugs Registration

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

General Registration

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
Card Details
Cardholder Name

WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

Anxiety & Depression Registration

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
Card Details
Cardholder Name

WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

Pain & Migraine Registration

You will be contacted for an appointment when we receive your completed form.

Date*
MM slash DD slash YYYY
First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*
Card Details
Cardholder Name

WE DO NOT SEE OR RETAIN CREDIT CARD INFORMATION!

Free Weight Loss Registration Form

Click here to complete the Registration!

Free Stop Smoking Registration Form

Click here to complete the Registration!

Free General Registration Form

Click here to complete the Registration!

Trim-Style Weight Loss Recordings

These are Weight Loss Meditation Recordings for behavioral and emotional change that gets to the source of unhealthy habits. These recordings include psychological techniques to eliminate fattening foods, cravings, reduce portions, snacking, as well as to reduce stress and emotional eating. Consistent listening and applying the weight loss strategies will increase the desire for healthy foods, water and physical activity. They are extremely relaxing and produce an enduring state of calmness. Choose the recording(s) below that address your needs for creating weight loss habits. DO NOT LISTEN & DRIVE!

First Name*
Last Name*
Email*
Phone*
Weekly Weight Loss Recordings*
- Receive ALL (10) Weight Loss Recordings
- Portion Control & Snacking
- Eliminate Craving for Sugar & Salt
- Increase Exercise Mortivation
- Stop Stress Eating
- Hunger Control. Know when to stop
- Increase Self-Esteem Reduce Weight
- Stop Sabotaging Weight Loss
- Relapse Prevention Stay Focused
- Stop Emotional Eating
- Increase Metabolism Subconsciously
These (10) weight loss recordings are $19.95 each a $199.50 value. However purchase all 10 now and receive them for $149.50 a $50 savings on these effective weight loss and stress control recordings.
Select the Offer*
- Receive (10) Weight Loss Recordings. Purchase NOW & get all (10) for $149.50
- 1 Recording - $19.95
- 2 Recordings - $35.00
- 3 Recordings - $54.95
- 4 Recordings - $74.90
- 5 Recordings - $94.85
- 6 Recordings - $114.80
- 7 Recordings - $134.75
- 8 Recordings - $154.70
- 9 Recordings - $174.65
- 10 Recordings - $194.60
Total
$0.00
Credit Card*
WE DO NOT RETAIN CREDIT CARD INFORMATION!

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Pain Relief and Relaxation Recordings

There are (2) Pain Control Recordings that reinforce private and group pain management sessions. They produce deep relaxation, restorative sleep and include psychological pain relief techniques. They are not intended to treat medical conditions. Do not stop taking prescribed medication without your doctors advice. Do not listen and drive. Your recordings will be delivered via email. Receive (1) $19.95 or (2) $35.00.

First Name*
Last Name*
Email*
Phone*
Select the Offer*
- 1 Recording - $19.95
- 2 Recordings - $35.00
Total
$0.00
Credit Card*
WE DO NOT RETAIN CREDIT CARD INFORMATION!

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Corona Anxiety Stress & Depression Release

There are more than (8) different recordings that are intended to reinforce private and group teletherapy sessions. They produce deep relaxation, restorative sleep, supports the immune system and include psychological techniques for positive change. Do not stop taking prescribed medication or listen when driving. Your recording will be delivered via email. Receive (1) $19.95 or (2) $35.00.

First Name*
Last Name*
Email*
Phone*
Select the Offer*
- 1 Recording - $19.95
- 2 Recordings - $35.00
Total
$0.00
Credit Card*
WE DO NOT RETAIN CREDIT CARD INFORMATION!

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Short Therapy Session

Register & Pay $35 for Office Consultation

First Name*
Last Name*
DOB*
MM slash DD slash YYYY
Age*
Marital Status*
Occupation*
Email*
Phone*
Office Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

This is strictly confidential! You will receive absolutely FREE a Behavioral Weight Loss Session in the comfort of your home.

Date*
Name*
Email*
Mobile Phone*
Please provide the name of the person who referred you?
You receive FREE weight loss recording when you join our weekly behavioral sessions. It is a $19.95 value.
Attending with a group?*
- Yes
- No
What Group?
Please check your email for the date, time and tele-conference number to access the private weight loss session. (When you enter the tele-conference DO NOT Announce Your Name if you wish to remain anonymous.).

Request An Appointment

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Alcohol & Drugs
Stress Free
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Test Anxiety
Gambling
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Register For Consultation at Home

- Initial Consultation $35 Click Here

Dr. Clinton W. Smith, Psy.D

Clinical Behavior Therapist & Guided Meditation

For Assistance:

Call Us: (334)440-6174
Email Us: DrClintonWSmith@gmail.com