Wait List Form
Select therapist may at times become fully booked. Please join our waitlist form. We will notify you as soon as your desired therapist becomes available. Upon contact, we will send and email and a text message letting you know if any availability opens up. Please note that after this attempt to contact you, slots make become unavailable once the next person on the list is contacted 1-hour after later.  
Sign in to Google to save your progress. Learn more
Email *
Which clinician are you looking to work with? *
Name *
Email *
Phone number
What type of therapy are you looking for
Clear selection
What do you need support with?
Comments
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy