For any questions or to schedule an appointment, please fill out this form and someone will be in contact with you shortly.

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 speaking with you soon.

Name *
Name
Parent/Caregiver: (required for anyone under 18)
Parent/Caregiver: (required for anyone under 18)
Phone:
Phone:
Preferred Location: *
What are your day and time preferences for scheduling? We'll do our best to provide you with available appointment times based on this information.
Briefly describe your reason for seeking therapy today. This field is not required. We encourage you to share details only if you're comfortable doing so.
Insurance
If available, please provide your insurance information below.
Insurance Company:
BCBS: Include three-letter alpha-prefix TRICARE: Include policyholder's SSN or 11-digit DoD Benefits Number (DBN)
Patient's Date of Birth:
Patient's Date of Birth: