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Make An Appointment
Who We Are
Pre-Doctoral Psychology Trainee
Pre-Doctoral Psychology Intern
Post-Doctoral Psychological Assistant
Therapy Patient Request
Patient First Name
Patient Last Name
Parent or Guardian (If Patient is under 18)
Patient Date of Birth
Best time to be reached?
All of our providers have speciality areas in depression, anxiety, and trauma related concerns. Is there anything more specific that you need help with?
How long has this been a concern?
Is there anything that has happened recently that has made you want to call us for services?
Have you ever been in therapy before?
If yes, how long ago?
Is there anything else you want to share that would be important for us to know?
Choose an option
Other Insurance Type (If Necessary)
Insurance Member ID
What is the name of the primary person on the insurance policy?
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or our out-of-pocket rates)
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