PRCG New Client Appointment Request Form
Finding the right therapist is an important part to the beginning of your therapy journey. Please take a moment to fill out this form so that our admin team can assist in matching you with the best therapist to service your needs and gather some information necessary to get your journey started.

Most correspondence is conducted via email, but we understand that email does not always meet the needs of those we service. If you would also like a phone call to complete the process, you will have the option to schedule at the end of this form.
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Email *
What is your name? The name/names of your dependents/spouse if they are seeking services? *
What is your phone number? *
May we leave a message on this number? *
Who are services for? *
Required
Date of birth of person/persons services are for *
Please select your payment method. Below are the accepted forms of payment *
Required
Do you have a preferred therapist? (As space can be limited we cannot always guarantee your preferred therapist. We aim to match each inquiry with the best therapist for your needs).
Which appointment window would work best for you (we will try to match you with a therapist we believe fits your needs as well as your desired schedule)
Briefly share some concerns you would like to address or goals for therapy you would like to accomplish
Describe what you are looking for in a therapist, (example: someone that is direct, has a gentle approach, understands spirituality, a therapist that gives homework play therapy, etc)?
You will receive email correspondence regardless but if you would also like a phone call please select a day and time from the options below. Intake phone calls are usually 10-15 minutes long.
How did you hear about us? *
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