Get in Touch with Us

We know taking the first step to get help can be tough, but we’re here to make it as easy as possible. If you’re looking for support, just fill out the form with your contact information and let us know what you’re dealing with. We will reach out to you soon.

Name

First Name

Last Name

Phone Number

Please enter your preferred contact number including area code

Email Address

Date of Birth

Please enter month/date/year

Please provide short summary of what concerns you hope to be seen for.

In a few sentences, explain what issues you'd like to address in counseling. This will help the counselor prepare for your session.

Clinician

Choose Your Preferred Therapist

When is your typical availability to meet?

Please indicate your general availability by listing days and times.

How would you like to attend your sessions (Mark all that apply)

Online (Telehealth)

In Person

No Preference

How will you be paying for your sessions?

Self-Pay

Insurance (If using insurance, please provide the name of your insurance provider.

Insurance Provider Name

(Please enter the name of your insurance company.) Complete only of If insurance is selected.

How did you hear about us?

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