Request a Mental Health Appointment
Tell us how soon you’d like to be seen and share your service, insurance, and contact details.
How soon would you like to be seen?
*
Today / Same Day
Within 1–2 days
Within 1 week
Within 2–4 weeks
Just exploring my options
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What mental health service are you looking for?
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Therapy / Counseling
Medication Management
Both Therapy & Medication Management
Not sure — I need help deciding
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Do you currently have health insurance?
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Yes
No
Not sure
Who is your insurance provider?
*
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How did you hear about Adaptive Behavioral Services?
Google
Facebook
Instagram
Friend / Family
Healthcare Provider
Insurance Company
Other
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First & Last Name
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First Name
Last Name
Mobile Phone Number
*
We’ll text you to help schedule your appointment.
Format: (000) 000-0000.
Submit Request
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