Name *

Email *

Phone *

Do you have a therapist you'd like to work with? *

Comment or Message *

Add dates/times for consultation call or details you'd like more information about here. Please be sure not to submit any health information via this form.

Subject *

How Did You Hear About Us? *

Don't worry, we won't contact them! We just like to know how folks find us!

Please note, we are out-of-network providers for all insurance plans. We can provide documentation you can submit for possible reimbursement, but we can't guarantee reimbursement. *

By checking here, I acknowledge that all providers are out of network with insurance.