Request an Appointment with a Therapist

We’re so glad you’re here. Reaching out for support takes courage, and we’re honored to walk alongside you. Please fill out the short form below, and our team will begin working to match you with a therapist who can best support your needs. If you have any questions, we’re here to help.

- The Lifeline Team
Name

First NameLast Name
Age
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Reasons for Seeking Therapy
Do you have a preference for Day of Week and Time of Day, or would you like our first available appointment?
WeeklyEvery 2-3 WeeksMonthlyEvery 6-8 WeeksQuarterly
In Person: Tuscaloosa or NorthportIn Person: BirminghamTelehealth
Plan to Utilize InsurancePrivate Pay
Blue Cross Blue ShieldLucetUprise HealthCignaTELUS Health (Previously BHS)Humana/TricareUnited HealthcareMutual of OmahaVIVA HealthPrivate Pay
Do you have any questions for us before we schedule?
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How did you hear about Lifeline?
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