Appointment Request - CONFIDENTIAL
The Peacemaker Center
New clients who want to set up an appointment at The Peacemaker Center should complete our confidential Appointment Request form. It is submitted securely to our Intake Coordinator who will review it and assign a therapist who will reach out to you to schedule your initial appointment.
If this is an emergency, please dial 911.
Client #1 Information
Couples or 2 Children under age 14 fill in both Client #1 and Client #2 information
Client #2 Information
Note: We do not take insurance and are not in network with insurance companies but our therapists will, on request, provide a receipt with the proper codes that can be submitted to your insurance company for out-of-network reimbursement of our fee. Our fee is based on a sliding scale with full pay on the scale set at $125/fifty-minute session. We can offer a reduced fee to those in need, based on our sliding scale.