Your therapeutic journey starts here.
Thank you for your interest in our service and responses! Please note that your responses are secure, private, confidential, and HIPAA compliant. All of this information requested on this form will need to be completed, especially if you are planning to use insurance, in order to request services as well as prompt the insurance verification, registration, and scheduling process. If you are a parent/guardian completing this form on behalf of your child, please provide their information as the identified client. If you are looking for Couples Therapy, please designate one member of the relationship as the identified client and fill out the form as such.