CMC Therapy Official Appointment / Referral Request Form
We're glad you're taking the first step to feeling better.

At CMC Therapy, we live by our motto: "be kind to the mind", that includes your own mind and those of others. It’s okay to not have it all together. Being vulnerable and transparent about where you are in life is no easy task, and takes courage. Therapy can help you feel empowered to make the changes that reflect the life you want to live.

This is our official appointment/referral request form. Please fill out as much information as possible so our Client Care Coordinator can connect you with a therapist that can help your specific needs.

If you are not the client, please answer the questions below in regards to the client that will be seen at CMC Therapy. Our Client Care Coordinator will be in touch very soon to talk to you more about scheduling your first appointment.
Email address *
Is this referral for you or for someone else? *
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