Truckee Therapy Appointment Request
Please use this form to be added to our wait list.  Give us a call at (530) 285-3335 ext 7 if you have any questions, or for a faster response, email us at truckeetherapy@gmail.com.  Once your form is submitted, someone from our team will reach out to you confirm your spot on the wait list.  Thank you!
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What is your full legal name? *
Date of birth (for insurance verification) *
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DD
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Email Address *
Phone Number *
How would you like be contacted? *
Required
How did you hear about Truckee Therapy?
Preferred Therapist (okay to pick more than one)
What type of therapy are you seeking? *
Location Preference
Reason for seeking therapy *
Do you plan on paying with insurance? *
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