Start the conversation

Request an appointment.

Complete the scheduling information below. Required sections must be completed before the request can be submitted.

Client inquiry form

Fields marked with * are required. This form is for contact and scheduling information only.

Full legal name *Email address *Phone number *State where you are located *

Payment method *

Medicare Private Insurance Cash Pay / Out-of-Pocket

Select at least one payment method.

Session type *

Initial Evaluation Individual Therapy Follow-up Session

Select at least one session type.

Preferred days *

Select at least one preferred day.

Preferred time of day *

Morning (8:00 AM–12:00 PM) Afternoon (12:00 PM–4:00 PM) Evening (4:00 PM–8:00 PM)

Select at least one preferred time.

I understand that this is a scheduling inquiry only, that I should not submit diagnoses, symptoms, crisis details, or other private medical information, and that submitting this form does not guarantee an appointment.

After the first test submission, FormSubmit will email the practice a one-time activation link. Requests will be delivered automatically after activation.