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Request An Appointment
Thank you for reaching out to our practice and taking a big step towards your mental health and wellness! Please fill out the form to request an appointment. You will receive a response from us within 24 hours.
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* Indicates required question
Your Name:
*
Your answer
Your Email:
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Your answer
Phone Number:
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Your answer
Preferred Method of Contact
By checking the box for "Text message", you consent to receive text messages from our practice.
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Phone call
Email
Text message
Required
Preferred EMDR therapist (You can also self schedule appointment using this link: https://mindspace.theraplatform.com/#/scheduler/ui)
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Rebecca Blankenship, EMDR Therapy
Sheryl Reto, EMDR Therapy
Lin Hu, EMDR Intensives
What type of appointment are you requesting?
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Free 15-minute phone consultation
Initial clinical assessment (60 minutes)
60-minute screening for EMDR intensives
Please list the top 3 issues you want to address with therapy.
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Your answer
How do you plan to pay for services? (Please note that insurances generally don't cover intensives.)
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Insurance
EAP
Self pay
What is the name of your insurance or EAP company, if applicable?
Your answer
How did you hear about us?
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Google
Lyra Health
My insurance
Past or current client
Friend/family
Headway
Psychology Today
Therapy Den
Mental Health Match
My doctor
My therapist
Other:
Thank you again! We will get back to you shortly!
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