*New Client Inquiry Form
Thank you so much for reaching out to inquire about therapy at Pulse Wellness Cooperative. We would enjoy the opportunity to work with you.

Please complete the following questions to help us better understand your needs. A member of our team will contact you within 1-2 business days to follow-up. 

If you are experiencing a mental health emergency, please call 988, 911, or visit your nearest Emergency Dept.
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First Name *
Last Name *
Date of Birth *
Email Address *
Subscribe to our monthly newsletter?
Phone Number *
Who is your insurance provider(s)?
*Please refer to our website to see who we are in network with!
 *
Have you been in therapy before? *
How often do you want to meet? *
What brings you to therapy? 
Is there something specific you look for in a therapist?
 *
What form of therapy are you seeking? (check all that apply) *
Required
Is there a clinician(s) at Pulse you were hoping to work with? (can check more than 1) *
Required
How do you prefer to attend therapy? *
How did you hear about Pulse Wellness? *
If you are interested in connecting with Tracy Andrews for a consultation, please follow this link to her New Client Inquiry Form. She will reach out to you directly at her earliest convenience. 
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