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How Can We Help?
Complete this short form so our team can better understand your needs and guide you clearly.
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First, what’s needed right now?
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Choose the main reason for reaching out
Therapy (CBT, DBT, EMDR, etc.)
Medication review or possible change
Current medications aren't effective
Struggling with depression
Exploring TMS
Exploring Spravato (Ketamine)
Unsure, open to guidance
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2
How soon?
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How soon are we looking for?
Urgent/ASAP
Within 2 Weeks
No Rush/Flexible
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3
Full Name
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Who are we helping?
First Name
Last Name
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4
How should we contact?
What is the preferred method of communication
EMAIL ADDRESS
PHONE NUMBER HERE
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5
Are we good to reach out?
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Our team needs permission to contact for care and scheduling.
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No
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