This form is for new intake appointment requests with Yana in the Brattleboro, VT office only!
Please fill out this form to request a new intake appointment with Yana Tallon-Hicks, MA, individual and relationships therapist in her Brattleboro, VT office. This office is located in the Soma Wellness Center in downtown Brattleboro at 167 Main Street, Suite 312.
Yana sees clients in Brattleboro on Mondays, Tuesdays, and Wednesdays. If you'd like to request an intake to see Yana at the Couples Center of the Pioneer Valley in downtown Northampton, Ma, please instead visit https://pioneervalleycouplestherapy.com/ to do so.
**** CONFIDENTIALITY NOTICE ****
Please note: GoogleDocs, GoogleForms, and/or email are not secure or confidential ways to communicate. Never send sensitive or confidential information via these formats unless you have carefully considered the risks in doing so.
For this reason, the majority of your sensitive, personal, and/or identifying information will be gathered in-person via physical intake paperwork at your scheduled intake appointment. Please only use this GoogleForm to request an intake appointment if you have considered the confidentiality risks of doing so.
Otherwise, please request an intake appointment in the Brattleboro office via phone by calling Yana directly at 413-813-8828.
Yana can be reached by cell phone or email to discuss scheduling and other logistical details within business hours. However, therapeutic content is not best discussed through these channels and should be discussed during session.
I offer non-crisis therapeutic support and options. If there is a mental health crisis and you require immediate assistance:
Health Care and Rehabilitation Services of Southeastern Vermont (HCRS) offers local 24/7 mental health crisis support at 1-800-622-4235 and the National Suicide Prevention Lifeline can be reached 24/7 at (800) 273-8255.