New Client Request Form
We are honored that you are interested in services at Back on Track.  We would love to be able to provide services to everyone who reaches out, however,  WE ARE CURRENTLY RUNNING A WAIT LIST FOR NEW CLIENTS.  The wait time for new client intake appointments depends on a number of factors including:  insurance, therapist requested, time of day you can attend, etc.  Currently your wait could be anywhere from a few days to a few months depending on these factors.

By completing this form, you will be added to the list.  

Please do not be alarmed if you do not hear from someone immediately.  WE WILL ONLY REACH OUT TO YOU IF WE NEED ADDITIONAL INFORMATION OR IF WE BELIEVE WE HAVE AN INTAKE APPOINTMENT THAT WILL WORK FOR YOU.  

We will periodicallly reach out to everyone on the list to ensure that they are still interested in services.
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I understand that by completing this form, I will be added to a waitlist.  I also understand that someone will only reach out to me if/when an intake spot is available. *
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