Request to Be Notified
Currently we do not have a therapist available who is offering the services you are looking for, so please continue looking elsewhere to find the help you need. However, if you would like us to contact you to see if you are still interested if a therapist becomes available, please complete and submit the form below.
Who are you seeking an appointment for? (Mark all that apply)
My Spouse/Significant Other
Mark the type of therapy you are looking for. (Mark all that apply)
What kind of group would you be interested in attending?
Help Us Find the Right Therapist for You
I am seeking an appointment for a new client
I am an existing or previous client
Which therapist's waitlist would you like to go on? *Please note if you are doing family counseling all individuals seeking counseling need to meet the age requirements for the therapist
First available to meet my needs
Seth Haney--Works with ages 7+ in Individual and Family Counseling
Norman Haney--Works with ages 12+ in Individual, Couples Family and Group Counseling
Wendy Dyck--Works with ages 18+ in Individual Counseling
Michael French--Works with ages 18+ in Individual, Couples and Family Counseling
Jeanneen Morris--Works with ages 13+ in Individual, Couples and Family Counseling
Joshua Harms--Works with ages 13+ in Individual, Couples and Family Counseling
James Lehnardt--Works with ages 16+ in Individual and Family Counseling
Approximately how long ago was your last appointment
I have seen this therapist within the last 3 months
3-6 months ago
7-12 months ago
More than a year ago
I don't know
Age group you are seeking help for, please mark the appropriate age range of client(s).
2-3 years old
4-6 years old
7-12 years old
13-17 years old
18-21 years old
22-29 years old
30-64 years old
Briefly describe your presenting issue and reason for coming in.
Do you have specific criteria you are hoping for in a therapist?
List anything else specific you were hoping for in a therapist.
How did you hear about us?
Be specific, for instance if a friend referred you, please write your friend's name.
List all individuals you are seeking therapy for
Schedules vary depending on the therapist. Our evening and weekend appointments fill up quickly and may not be available for scheduling.
Select ALL days/times you could make work with your schedule.
I am flexible and can make any time work
Mon mornings 10 am-12 pm
Mon afternoons 1 pm-4 pm
Mon evenings 5 pm-8 pm
Tues mornings 8am-12 pm
Tues afternoons 1 pm-4 pm
Tues evenings 5 pm-8 pm
Wed mornings 8 am-12 pm
Wed afternoons 1pm-4pm
Wed evenings 5 pm-8 pm
Thur mornings 10 am-12 pm
Thur afternoons 1 pm - 4 pm
Thur evenings 5 pm - 8 pm
Fri mornings 8 am - 12 pm
Fri afternoons 1 pm - 4 pm
Fri evenings 5 pm
Sat morning 8 am-12 pm
Sat afternoon 1 pm - 4 pm
If we have a therapist available that meets your needs, we will email you some paperwork so we can finish setting up an appointment. Each individual attending therapy will need their own set of paperwork completed.
Person filling out this form's Name
Person filling out this form's Email
Person filling out this form's Phone Number
Spouse/Significant Other’s Name
Spouse’s/Significant Other’s Email
Spouse/Significant Other's Phone Number
Each family chart is set up under one client name. For family sessions, which family member would you like the chart to be set up under.
Add any additional information you feel is important for us to know before setting up an appointment (optional)
Should be Empty: