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Appointment Request
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Email
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Your email
Name (If for child under 18 please list child and parent's name)
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Date of Birth
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Preferred Pronouns
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Phone Number
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Preferred Contact Method
Phone Call
Email
Text Message
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How did you hear about us?
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Which therapist(s) are you interested in seeing?
Open to Seeing
Most Preferred
Any therapist asap
Stacey Burgess
Veronica Clyburn
Jo Lynn Courtney-Johnson
Amy Dupre
Angela Eubanks
Amy Foreman (Virtual Only)
Rachel Hughes
Leah Hutchings
Courtney Kincaid
Maddie Miller
Tiffany Musheagan
Carla Schellhorn
Hayden Scott
Desmond Shepherd (Virtual Only)
Brandyn WIllis
Ron Wood
Rebecca St Clair
Open to Seeing
Most Preferred
Any therapist asap
Stacey Burgess
Veronica Clyburn
Jo Lynn Courtney-Johnson
Amy Dupre
Angela Eubanks
Amy Foreman (Virtual Only)
Rachel Hughes
Leah Hutchings
Courtney Kincaid
Maddie Miller
Tiffany Musheagan
Carla Schellhorn
Hayden Scott
Desmond Shepherd (Virtual Only)
Brandyn WIllis
Ron Wood
Rebecca St Clair
Please check all days/times you are available
Any time
8-10 am
11 am - noon
1-3 pm
3 pm
4 pm
After 5 only
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays (AM only)
Any time
8-10 am
11 am - noon
1-3 pm
3 pm
4 pm
After 5 only
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays (AM only)
Health Insurance
Aetna
BCBS
Cigna
Friday Health Plans
Health Choice
UMR/United/Optum
Other:
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