New Client Appointment Request

Existing clients, please use the portal to schedule appointments.

We are so HAPPY you made it this far!

•If you have not done so yet, please visit our common questions page so you know what to expect at this clinic.

•We want you to have the best experience possible as we know for most people, it was already hard getting this far.

•If you are ready to DO THINGS DIFFERENT, don’t delay. It is COMMON to attend therapy with several different therapists before you find the right fit.

•Please know that onboarding takes the same amount of time at all clinics (15-20 minutes).

•YES, we know it’s not fun to fill out forms but they are required by insurance.

•Once you have filled out this appointment request form, someone will email you within 24 hrs (during normal business hours) to get you set up with the best fit therapist. Check your SPAM because often times communication goes there since we are not in your contact list.

•Please indicate below, which insurance plan you carry. If you don’t see your plan below it is because we are not in-network with them. We do not bill out of network plans.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This appointment request form is for general demographic information to get you set up in the portal for onboarding.

Date of birth and gender is required to verify insurance and to start a portal. It must match the info your insurance plan has about you.
**We can only bill Medicare if you have a commercial plan that is primary to your Medicare plan. We do not have a contract with Medicare. We can only bill the above mentioned plans and only if they are primary insurance plan. If you see your plan above, this does not guarantee payment. You can call into your insurance and verify we are in-network with your specific plan. We do not bill secondary insurance. If you choose self-pay, you can request flex spending statements to submit to your insurance if you don’t see your insurance above. ***BY FILLING OUT THIS FORM YOU ARE AWARE YOU ARE SHARING PERSONAL INFO THROUGH A SECURE FORM THAT DOES NOT QUALIFY AS HIPAA COMPLIANT
Select all that apply
Please put N/A if you do not have any preference.
Do not go into great detail because this is not a HIPAA compliant form. Just a few general symptoms.

By clicking ‘Submit’ you agree that the phone number you provided may be used to contact you.