Waitlist Only

At this time we are able to add clients of all ages to our waitlist. Please fill out the form below and one of our staff will contact you.

We are unable to take any referrals for REUNIFICATION THERAPY at this time.

We will only send you the information you request and cannot respond to mental health crisis or emergencies. If you are experiencing an emergency please call 911 or for mental health crisis support please call 988.

New Client Name

If new client is a minor please include all parent's names in the message box below.

First Name

Last Name

Email Address

Phone

(###)

###

####

What type of of Insurance will you be using?

Please let us know if you have more than one you will be using.

What type of therapy are you looking for?

Let us know your availability for appointments

Are you willing to work with a student clinician?

Yes

Do you have preference of in-person or telehealth?

Message

Guardian (if needed)

First Name

Last Name

Electronic communication cannot be guaranteed as confidential.