Free consultations are limited to one per patient per clinician, but we are happy to facilitate having multiple guardians and/or responsible parties join the virtual consult.

Request Appointment

Unsure which clinician will best suit your needs?

Tell us a little more about yourself and what you’re looking for. We will be in touch to answer any questions you might have and get you started on the right treatment path.

Name (Person Needing an Appointment) *

First Name

Last Name

Preferred Pronouns *

Name (Person Completing This Form) *

If you're requesting this appointment for someone else (including a child or family member) please enter your name.

First Name

Last Name

Date of Birth (Person needing an appointment) *

This information is used to best match you with an appropriate clinician.

YYYY

Email *

Phone

(###)

###

####

Street Address

State *

Zip Code

Preferred Method of Contact *

We will be in touch with more information and next steps. How would you prefer to be reached?

Phone

Both

Are you interested in In Person, Telehealth or Both? *

What types of therapy are you looking for? *

Please select all that apply.

Individual Psychotherapy

Medication Management

DBT Therapy/Coaching

DBT Skills Group

Couples Therapy

Family Therapy

EMDR

Hypnotherapy

ADHD Testing

Nutritional/Genetic Testing, Supplements

Please tell us briefly why you are seeking treatment *

Clinician Preference

While not all of our clinicians may have availability, please let us know if you have a certain clinician in mind. You are welcome to read more about clinicians on "Our Team" page, or we would be happy to assist you in deciding who might be the best match.