Schedule an Appointment for Counseling

Unfortunately, we are not accepting new clients at this time and are filled to capacity.

If you are a client who would otherwise be new to us, we appreciate your interest and can place you on our waitlist for future counseling services, group sessions, or community workshops.

Thank you!

Name*
First Last
Preferred name
Gender
Personal pronouns
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Cell Phone*
Home Phone
Best time to reach you
Date of birth*
MM
DD
YYYY
Health insurance plan name (type in N/A if self pay)*
Health insurance plan ID Number (type in N/A if self pay)*
Copay information
Desired service
What is bringing you to therapy?*

Schedule an Appointment for Counseling

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