Thank you for completing this initial intake form. Our Intake coordinator will be contacting you to further discuss. Our goal is to set you with the best therapist, coach or counselor that meets your specific needs.
Please complete the Pre-authorization Registration link located on the forms page of our website. This will help us pre-authorized any insurance and /or register you as a client/patient for our center.
Pleae complete the payment and credit card section as well. This can be found on the forms page of our website. You will receive instruction from our intake coordinator on this to help you in any way we can.
Do not hesitate to call us with any question you may have. We can also assist you in filling out this form together online, by phone, by video conferencing or at our center with a set and complimentary appointment set aside for you to see the center and ask any further questions.