Please contact us by phone at 888.234.7628 or complete the form below to request an appointment. We will do our best to accommodate your needs and availability!

To schedule/request an appointment with us, please fill out the form below to the right. Once we receive your request, one of our counselors will contact you to discuss your current challenges to make sure they are a good fit for you and can meet your needs. Submitting this request form does not indicate a confirmation of the requested appointment. We will do our best to meet your scheduling needs and will discuss this with you via phone.

NOTE: If this is an emergency, please call 911 or go to your nearest emergency room. We require a 24 hour cancellation notice to avoid missed session fees. 

Name *
Name
Preferred Appointment Day *
Counselor Preference *
What best describes your interest in requesting services? *
Please select all they apply.