New Patient Appointment Request
We are looking forward to working with you! To get started, please complete this form in its entirety.

Please be advised that we do NOT offer psychiatry/medication management services at TCFHAR.

At the conclusion of this form, you will have the opportunity to select available new patient appointment times.

Email address *
Referral Source
Treatment Need *
Therapy Service Requested *
Preferred Locations *
Required
Preferred Appointment Days
Preferred Appointment Times
Next
Never submit passwords through Google Forms.
This form was created inside of The Center for Healing & Recovery. - Terms of Service
Google Forms