Book Now Form

1

Which service are you looking for?* This field is required.

Licensed Mental Health Therapy

Certified Life Coaching for Adults

Something Else

Occupational Therapy

2

Are you expecting to use insurance?

Yes

No

3

Insurance Information

We do not accept insurance for a variety of reasons surrounding how the system works; however we have partnered with Lauren Diaz LCSW, PLLC who sees teens and adults and accepts various forms of insurance. She is located inside The Hope Place.

To read more information about that you can click here.

To find another therapist who accepts your insurance, we recommend going to Psychology Today and searching by your zip code and the insurance you would like to use.

Click next to continue the form to see who else we recommend.

4

Please Select the Client's Age or Type

Child from 2-12 years old

13 to 17 years old

18+ Adult

Couple Counseling

Something Else

5

Would you like us to reach out to you?* This field is required.If so, click yes and enter your information. If not, click no and you will be directed to your booking page. Please be aware that our front desk is usually available Monday thru Thursday from 9am to 5pm.

YESNO

6

Great! Please fill in your information below and someone

will contact you as soon as possible.

First Name * Last Name *

Email *

Phone number where you can be reached:

Phone Number

Do you have a preferred time that we call?

Click Submit and we will reach out.