Request an Appointment
Thank you for contacting Freedom Within Therapy and Wellness Center (FWC). Please complete the following and our Client Care Coordinator will reach out to you to further discuss your needs and assist in getting you scheduled.
How did you hear about us?
My insurance company
Preferred method of communication:
Email (Please note email is not considered a secure form of communication)
Text (Please note text is not considered a secure form of communication)
I consent to the following methods of communication and am aware that neither email or text are considered secure forms of communication. Please check any/all that apply.
Monthly newsletter where FWC shares helpful mental health and wellness tips
What is the best time of day to contact you? Check all that apply.
Late Afternoon (2-5pm)
Are you wanting to use insurance? If so, what insurance do you have?
Type of therapy:
Telehealth (video counseling)
Open to either
Is there a particular therapist you are hoping to schedule with?
What are you seeking counseling for?
Women's health including postpartum
What is your availability for therapy appointments? (Days and times)
Is there anything else you would like us to know?
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