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Interest Form for New Clients

Please use the form below to let us know what you are looking for and also to make scheduling faster and easier.


1. Fill out this form (make sure you click submit!)


2. After you complete this form, you will be prompted to schedule a call with us to discuss availability and to book your first appointment. This will help us avoid phone tag.


If this is an urgent, life-threatening issue call 988, 911, go to a local hospital, or call your local crisis line.


DISCLAIMER: Please only send your basic contact information and we can discuss your needs in more detail over the phone. Completing this form does not constitute a therapy relationship, guarantee confidentiality, availability or appointments.

Age range of prospective client (s)
Contacting us about? Choose 1 or more:
Service(s) you are interested in, check all that may apply:
Preferred location(s) for therapy appointments - check all that you are open to:
Days of the week you are available for appointments
Times you are available for appointments: ***NOTE - Appointments after 2pm are in high demand and are rarely available. Please let us know all of your availability so that we can work to find a time that fits your schedule!**
Preferred Provider
Form of Payment: ***Note the insurances listed are the only ones we accept and this can vary based on the individual provider and meeting medical diagnosis criteria.**
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