Please note entering your email address represents consent to electronic communication. We do not send marketing/promotional emails. Emails are limited to information and correspondence specific to you and/or your family.
Please Note: Settings for appointment reminders are copied over to the updated phone number unless otherwise requested. Changes to reminders can be made by submitting another form.
*This is usually applicable to child/adolescent clients. If you're an adult in individual therapy and would like this to be the main contact on file, please select primary.
If two phone numbers are already on file, please share how you would like them to be managed.
If you set the new phone number as primary and the field below is left blank, we will assume the original number should be deleted and this one will be entered in its place.
Reminders are sent 2 calendar days before appointments
We're unable to enter card information directly through this form. Here are the options for adding/editing credit cards.
1. Portal: Add the card in the client portal. For step-by-step instructions, visit the client portal tab on our website and click "portal resources." You can also log in to the portal from this page.
2. Secure Document: We will email you a password protected form to input your information and add the card to your account.
You may close this form and log in to the portal or use the resources section for guidance.
If you need assistance, please contact:
email@example.com and we'll be happy to help!
The card entered below will be assigned as the default card.
We will send an insurance form to the email entered previously. Thank you for letting us know about your insurance change!
Please return the form as soon as possible so we may adjust claims and billing processes accordingly.
Therapists set private rates independently and we'd be happy to help you coordinate this transition.
Submitting this form indicates you are authorized to make changes to the client account.
We do not send confirmation emails as a measure to protect your privacy. We do, however, receive alerts for each request submitted and take care to be attentive to each one.