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Scheduling Contact Form
Thank you for reaching out to us at Fircrest Behavioral Health! We want to get you connected with the best care possible, so please fill out the form below and our scheduling coordinator will be in touch with you within 1 business day.
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First Name & Last Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Best Form of Contact
*
Call
Text
Email
No Preference
Seeking Services for:
*
Self
Other
If other, who are you seeking services for?
Your answer
Preferred Counselor
*
If you do not have a preferred counselor, please select "any".
Choose
Rebecca Lomeland, MA, LMHC
Bethie Cummings, MA, LMHC
Adam Wade-Garrett, MA, LMHC
Jackson Goforth, BA, Intern
Jennifer Vulgan, BA, Intern
Kristina Hargie, MA, LMFT
Aynsley Silva, MA, LMHC
Stephen Black, MA, LMHCA
Sarah Hart, MA, LMHC, CMHS
Maggie Peterson, BA, Intern
Kathryn Fitzgerald, Admin & Coach
Any
Are you hoping to use insurance?
*
Yes
No
If yes, what kind of insurance do you have?
Choose
Kaiser
Pacific Source
First Choice
Out of Network/Out of pocket
Are you interested in learning about how to pursue Out of Network Care with Superbills?
*
Yes
No
Maybe
Are you interested in working with a trained Counseling intern at a reduced rate?
*
Yes
No
Maybe
Best time to reach you:
*
Morning (9am - 11:30am)
Afternoon (1pm - 3:30pm
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