Appointment Request

To schedule an individual, child, elder, couples, marriage or family therapy appointment or to obtain additional information about any of these counseling services, please fill out the form below or give us a call.

*Please let us know what type of health insurance you have, brief reason for therapy request, preference for a male/female, online or in person, availability for appointment.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general information.

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Helpful Forms

Click here to view and print forms for your appointment.

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