Request an appointment

Please fill out the form below, and we’ll get back to you soon to confirm your appointment.

Full Name *

Phone *

Email *

Preferred Method of contact: *

What is the best time to reach you? *

How can we support you?

Desired time for appointments

Email Risk Acknowledgement and Use Consent *

This form is for scheduling purposes only and does not create a therapeutic relationship. Please do not include sensitive health information. I understand that the use of email and SMS text messages are inherently insecure and thus poses a risk to the security and confidentiality of my protected health information and I consent to therapists, providers, and/or office staff communicating with me via email or text message