Appointment Request Form
Please send us a message by using the form and we will place you on our waiting list in the order we receive your request.
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Email *
My Name *
Phone *
Email Address *
May We Leave a Message?
Primary Client Name *
Primary Client Age *
Your Relationship to Primary Client *
I'm looking for these services * *
How did you hear about us?
I'm Looking for Help Related To *
Our schedule for Anthem BlueCross and United HealthCare insurance clients are fully booked at this time, would you mind to be added on the waitlist?(Please note that we cannot predict our availability timeline, however, we will contact you based on first-come-first-serve from this waiting list.) *
My preference for therapist is: *
My preference for appointment times are: *
We understand the hourly rate for private individual therapy is quite high, therefore, we offer group therapy sessions which are quite effective and cost friendly. All our therapists have years of experience in running various group sessions. Would you be interested in participating in the group sessions with us?
Is there anything else that you would like us to know?
A copy of your responses will be emailed to the address you provided.
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