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Appointment Request
Hello! Thank you for your interest in starting therapy at Be Well - Wellness! Please fill out the following information and someone from our team will be in touch.
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Name
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Email Address
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Phone Number
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Location (City, State)
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Please describe your reason for seeking treatment.
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Please state your goals for therapy.
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Have you previously been treated for mental health concerns? If so, please briefly describe.
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What is your availability for appointments? (best days, times)
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What is your preference for appointments:
In-person
Virtual
A mix of in-person & virtual as needed
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How did you hear about us?
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Would you like to be added to Megan's mail-list to receive occasional newsletters with tips, tools, and information? (Unsubscribe at anytime).
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