Initial Lead Form

Answer a few quick questions to see if we’re the right fit.
It only takes a minute — and everything you share is confidential.

Name*

First NameLast Name

Email*

example@example.com

I consent to receive secure emails about scheduling and appointment updates.*

Yes

Phone Number*

Please enter a valid phone number.

I consent to receive secure text messages about scheduling and appointment updates. (Standard message rates may apply.)*

Yes

Please select the state where you will be physically located during your therapy sessions.*

How would you like to pay for your sessions?*

We accept insurance from select plans and private pay options.

What concerns, goals, or challenges are bringing you to therapy at this time?