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Contact Information


Thank you for considering us for your counseling needs.


To request an appointment we'll need some information from you and your family to get started. Please complete our new client intake form to save you and your family time before your first session. 

At the beginning of our first session, our therapist will briefly review the information sheet to make sure I have all information required for my records. We will also explain our policies regarding confidentiality and fees associated with your therapy. Please ask us any questions you have about therapy; as we are here to serve you and to make you comfortable during this process. If you would like a copy of our HIPAA Privacy Practices you can review them here.

Family Member 1 - Sex
Family Member 2 - Sex
Family Member 3 - Sex
Family Member 4 - Sex
Family Member 5 - Sex
May the therapist leave a voice or text message?
If necessary may we send mail to your address?
Marital Status
Appointment Time Preferences
Which days of the week do you prefer? (select all that apply)
Time of day you prefer? (Selet all that apply)
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