Become Our Client

Please fill out the information below and an intake worker will call you within 48 hours to offer you an appointment time. If you already have a counselor and need to submit your information for billing please list the counselor's name in the message area.

Please locate the appropriate intake packet from the list to the right and click the link to download and print the packet. Complete all the paperwork in the packet and bring it with you to your appointment. Thank you.

 

Personal Information:

Home Address

Insurance Information:

Treatment Information:

Appointment Location
CLICK HERE to see all of our available offices
Appointment Time
Message
Please add any information or comments that you think will help the counselor get a better understanding of your particular situation.

All of our therapists are licensed professionals. If you have any questions for your therapist you may ask them when the counselor calls to offer you an appointment.

The closest office location will be chosen according to your address unless otherwise chosen in the appropriate block above.

Once an appointment is scheduled for you we have a cancellation policy which requires 24 hours notice. If you are unable to give us 24 hours notice there is a late cancellation fee unless the cancellation is due to illness or emergency.

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