Please complete the Intake Form below in full.  Once your form has been submitted, we will be in touch within 1 business day (Monday-Friday) to reserve your appointment.

We look forward to connecting with you soon!

Contact Information
Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Can we leave messages at this number? *
Our Client Care Specialist is available Monday-Thursday from 10-6 and Friday from 9-3.
Address *
Address
Concerns
1 being "I couldn't be less concerned/the concerns don't bother me" and 10 being "I couldn't be more concerned"
If "Yes", when?
If you're working with multiple helping professionals, please select the most recent.
If "Yes", what other helping professionals have you worked with related to these concerns?
Please check all that apply.
Scheduling Appointments
What days are you available for appointments? *
Please check all that apply.
What times are you available for appointments? *
Please check all that apply.
How do you wish to receive appointment reminders? *
Reminders are sent 48 hours before your scheduled appointment.
We will do our best to match you with your preferred therapist, taking into account your concerns, availability, and therapist availability (note: some of our therapists currently have waiting lists).
Online therapy is a convenient, discrete way to access our high-quality services.
Please check with your insurance provider to confirm the details of your coverage prior to your first session.
A credit card number is required to reserve appointment times. We kindly ask that you have a credit card ready when we contact you to reserve your appointment. *