Request an Appointment
Please complete the information below to request an appointment as a new client. I will contact you as soon as possible. If you are experiencing a mental health crisis/emergency, call 911 or go to your nearest emergency room. (Note: If you are an EXISTING client, please contact me at 706-204-9303.)

The information you provide will be used ONLY to contact you in regards to your request.
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Your Name (First and Last)
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Your Phone Number (XXX) XXX-XXXX
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Your Child's Name (First and Last) ~ if you are seeking counseling for your child
Client's Date of Birth
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Client's Primary Insurance
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Select the PRIMARY reason you are seeking therapy for yourself (or your child).
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Select ALL reasons you (are seeking therapy for yourself (or your child).
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If you are experiencing a mental health crisis/emergency, call 911 or go to your nearest emergency room.

By submitting this form, you agree to allow us to contact you via the phone number listed above. You also agree that submitting this form is an inquiry and does not guarantee that you will receive an appointment. You will be contacted to obtain further details and information.
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