Request an Appointment
Please provide as much detail as possible when completing this form. The more information you share, the better we can understand your needs and schedule your appointment quickly and efficiently. Thank you!
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Client Name *
Client Date of Birth *
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Insurance Carrier *
Parent/Guardian Name (if applicable)
Phone Number *
Email Address *
Preferred Contact Method *
Please provide your full address, including street, city, state, and zip code.
Which of our clinic locations would you prefer to receive care at? *
What services are you interested in? (select all that apply) *
Required
Provider Gender Preference *
If applicable, what are the main areas you'd like to focus on or work through in therapy?
Have you ever been diagnosed with a mental health concern or condition? If so, please provide any relevant information.
If you're currently taking psychiatric medications, please provide the names, dosages, and how long you've been prescribed them.
What is your availability for appointments? Please be as specific as possible (e.g., any day before 10 a.m., Fridays only, after school hours only). *
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Sonder Behavioral Health and Wellness needs the contact information you provide to us to contact you about our services. You may unsubscribe from these communications at any time.

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