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Appointment Request
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Email
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Your email
Name (If for child under 18 please list child and parent's name)
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Date of Birth
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YYYY
Preferred Pronouns
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Phone Number
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Preferred Contact Method
Phone Call
Email
Text Message
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How did you hear about us?
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Which therapist(s) are you interested in seeing?
Open to Seeing
Most Preferred
Any therapist asap
Alex Aguilar
Judy Branum
Stacey Burgess
Julia Core
Jo Lynn Courtney-Johnson
Christie Degraffenfried
Amy Dupre
Angela Eubanks
Amy Foreman
Leah Hutchings
Rachael Johnson
Courtney Kincaid
Rose Reynlold-Cox
Carla Schellhorn
Hayden Scott
Desmond Shepherd
Brandyn WIllis
Open to Seeing
Most Preferred
Any therapist asap
Alex Aguilar
Judy Branum
Stacey Burgess
Julia Core
Jo Lynn Courtney-Johnson
Christie Degraffenfried
Amy Dupre
Angela Eubanks
Amy Foreman
Leah Hutchings
Rachael Johnson
Courtney Kincaid
Rose Reynlold-Cox
Carla Schellhorn
Hayden Scott
Desmond Shepherd
Brandyn WIllis
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
Any time
8-10 am
11 am - noon
1-3 pm
3 pm
4 pm
After 5 only
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Health Insurance
Aetna
BCBS
Cigna
Friday Health Plans
Health Choice
UMR/United/Optum
Other:
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