For any questions or to schedule an appointment, please fill out this form and someone will be in contact with you shortly. We strive to return all calls and emails within a 2-3 hour time frame during normal business hours.

We work with many different insurance providers and offer free verification of behavioral health benefits prior to scheduling. If available, please provide your insurance information.

Thank you, we look forward to assisting you.

What is your reason for contacting us?
Preferred Location *
Name of Patient *
Name of Patient
Name of Parent/Caregiver (If Applicable)
Name of Parent/Caregiver (If Applicable)
Phone *
Phone
Our scheduling coordinators will be able to offer available appointment times based on the information you provide here.
Insurance Information
We work with many different insurance providers and offer free verification of behavioral health benefits prior to scheduling. If available, please provide your insurance information below.
For BCBS, please include the three letter alpha-prefix. For Tricare, we need the policy-holder's SSN or DOD number.
Patient's Date of Birth
Patient's Date of Birth
Please let us know if you were referred by a medical professional, friend, family member, or colleague. Thank you.