top of page

Initial Request

Fill out the form below to help us match you with the right clinician.

Just click "Submit" when you're done. Thank you!

Which services are you seeking? Select all that apply.
Are you looking for short term or long term therapy ?
Are you open to meeting online and in-person ? Please note, our in-person sessions are limited.
What languages do you speak ? Select all that apply
Which of the following are you currently experiencing? Check all that apply.
Have you ever experienced any of the following (in the past)? Check all that apply.
Do you have medical insurance ?
Specify covered services if using insurance. Check all that apply. (See insurance contract for details.)
Would you like to be added to our waitlist if we can't schedule a session within the next two weeks?

Thanks for submitting your request!
We will follow up via phone or email as soon as possible, so please respond to our messages promptly.
Please add our email ( to your safe list so it does not inadvertently go to spam/junk.

bottom of page