Appointment Request
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Email *
Name (If for child under 18 please list child and parent's name)
Date of Birth 
MM
/
DD
/
YYYY
Preferred Pronouns
Phone Number 
Preferred Contact Method 
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How did you hear about us? 
Which office do you prefer?  Check all that apply.  
Tulsa Midtown
Broken Arrow
Tulsa South
Owasso
Most Preferred
Open to
Which therapist(s) are you interested in seeing?  List in order of preference.  You can check therapist profiles and availability  at https://resolvebhs.com/our-team/
Please check all days/times you are available 
Any time
8-10 am
11 am - noon
1-3 pm
3 pm
4 pm
After 5 only
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Sat/Sun
Health Insurance  (We cannot bill medicaid/soonercare)
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