• Request an Appointment

  • Phone: (833) 244-4878

    Email: appointments@talkthirdspace.com

    We're currently accepting patients and have same-week appointments available for eligible plans. Please complete this form so we can schedule your first appointment with us.

  • Who are you booking this appointment for?*
  • Which state are you located in?*

  • About the individual receiving services

    Please provide the following information for the individual receiving services. Ensure all details match exactly as they appear on the patient’s insurance card.

  • Date of Birth*
     / /
  • Format: (000) 000-0000.
  • Sex (as listed on insurance policy)*
  • Have you had an in-patient hospitalization in the past month for mental health reasons?*
  • Are you primarily seeking support for substance use (alcohol or drugs)?*

  • Session Preferences

  • What type of service are you looking for?*
  • Is this treatment court ordered?*

  • For Family Therapy & Couples Therapy, please provide the following information for the other individual(s) joining the session:

  • Format: (000) 000-0000.
  • Date of Birth of Partner/Spouse/Additional Member*
     / /
  • Sex (as listed on insurance policy)*
  • Which therapist(s) would you like to work with in Arizona?*

  • Provider bios can be found on this page.

  • Which therapist(s) would you like to work with in Colorado?*

  • Provider bios can be found on this page.

  • Which therapist(s) would you like to work with in Massachusetts?*

  • Provider bios can be found on this page.

  • Which therapist(s) would you like to work with in Virginia?*

  • Provider bios can be found on this page.

  • If your preferred providers are not accepting patients, can we match you with another provider?*
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  • Insurance Information

    Please provide the following information for the individual receiving services. Ensure all details match exactly as they appear on the patient’s insurance card.

  • Insurance Type*
  • Insurance Type*
  • Insurance Type*
  • Insurance Type*
  • Insurance Type*
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  • Is the individual receiving services the primary subscriber of this plan?*

  • Consents

    By submitting the form, you consent to Third Space using the times you provided to schedule your appointment with a therapist or psychiatrist. You can opt out at any time by contacting us at opt-out@talkthirdspace.com

    View our Privacy Policy and Terms

  • Do you consent to receiving SMS reminders regarding your appointment?*
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