Therapy Waitlist
Please fill out the following form to be added to the waitlist. The office will be in contact with you when the next appointment becomes available. 

Please note if this is a psychiatric or medical emergency, please contact your nearest hospital or contact 911 for assistance. If you are experiencing distress or thoughts of suicide, please contact 988 for 24/7 free and confidential support. Do not wait for an available appointment. 
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Date
MM
/
DD
/
YYYY
What are your current presenting problems bringing you to therapy? *
Phone number *
Email Address *
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