Therapy Waitlist
Please provide your contact information below if you choose to be contacted upon spots being available. The current wait is anywhere between 45-90 days. Thank you!
Email address *
Your name *
Phone number *
Preferred contact method *
Required
Insurance *
Required
Reason for seeking therapy *
How did you hear about me? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Smedley Psychological Services, LLC. Report Abuse