Therapy & Groups Services at Adventure Works
Please complete this form to let us know how our Adventure Works team can support you.

This form checked regularly during business hours and is not an appropriate method to seek crisis support. If you are experiencing a crisis, please call 988 or go to your nearest emergency room.
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Name of Client Seeking Services *
Your Name *
Your Relation to the Client Seeking Services *
Your Email *
Your Phone Number *
Age of Client Seeking Services *
Do you have a therapist preference?  *
What health insurance will be used for services? *
If you have an HMO Insurance plan, please state the name of the HMO and the name of the company you work for.
What Services are You Interested In? (Please mark all that apply) *
Required
Please respond to this question if you are interested in group services:

In what group(s) are you seeking to enroll? (You can select more than one box if needed.)
How did you hear about us?  *
Please add any personal message or additional details you would like us to know before we reach out to you. If there is nothing you'd like to add, please put "n/a."

Please note Google is not a secure form of communication. Please limit the personal information you share on this form.
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