New clients form
To become a patient, please use the form below. Please note we continue to have a high demand for our services as we enter 2024. We are doing our best to diligently work through our waiting list and get folks help as soon as possible. 

Depending on the type of insurance you have and your availability, we are scheduling new intakes 3-4 weeks out for ongoing counseling services. We will be in touch as soon as we have an opening.

Our medication provider is accepting new patients and has openings in approximately 3 weeks. 

Be sure to fill out all the insurance fields below so we can ensure if your insurance is active. Leaving it blank will only create a delay.
 
Thank you!

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Email *
Patient's First and last name *
Patient's Address *
City *
Zip *
Patient's Date of birth *
MM
/
DD
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YYYY
Phone Number *
Form of insurance *
Insurance ID Number (Please don't skip! Verifying insurance is the first step and will hold things up if we have to reach back out.) - If self pay just enter N/A *
Interested services *
Required
What is the reason for visit? *
What gender of provider would you prefer? *
What type of sessions do you prefer? *
If you want in person services, what office location? *
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