Let's Set Up A Time To Meet

Thank you for letting us assist you with taking the first step to make some powerful changes in your life.

One of our therapists will get back to you as quickly as possible to provide information on the therapeutic process, answer any questions you may have, and schedule an appointment. Therapists normally respond with in 24-48 business hours. The therapist can reach out over the phone, by email, or by text. To help us get in touch with you, please provide us with the following information, we look forward to meeting with you.

Please enable JavaScript in your browser to complete this form.
Is therapy for a:
Clients Name
Please type the name of the client. (if you are filling out this form for someone else, please put there name here and type your name into the Legal Guardian field).
Parent/Legal Guardian's Name
If services are for a child, please provide a parent or legal guardians name. Please provide the email and phone number for the individual that would be the best to contact.
What kind of services are you looking for?
Current Problem
Please check the boxes that Apply to the way you have been feeling lately.
What is the best Way to contact you?
What therapist would you like to meet with?