Interest Form
**We are currently in the process of transitioning our electronic record keeping software. These forms will be received and reviewed, though our response time will be delayed. Thank you for your patience as we update our systems to better serve our clients, prospective clients, and the Richmond community.
Please use the form below to inquire about our services. We have very limited availability for therapy at this time, especially after 3pm. We do have availability in our Tame Your Tiger program. We will contact you promptly via phone or email if we have a clinician available who may meet your needs. Completing this form does not guarantee availability or appointments. We can provide other resources to call if we are unable to meet your needs at this time.

Caseworkers and those making referrals for CSA or FAPT funded services, use this link:

 If this is an urgent, life-threatening issue call 911, go to a local hospital, or call your local crisis line.

DISCLAIMER: The contact form below is not HIPAA compliant. Please only send your basic contact information and we can discuss your needs in more detail over the phone.
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Email *
How did you hear about Heart & Mind? *
Name *
Email *
Phone *
Contacting About *
Insurance or Self Pay (Note; The insurances listed are the only ones we accept) TYT Program is self pay only (not covered by insurance) *
If we do not have an available provider who is in-network with your insurance, are you open to self-pay sessions with a Resident in Counseling at a rate of $75 per appointment? *
Age range of prospective client *
Types of Services you are interested in *
Preferred location(s) for therapy appointments: *
Your Availability (Other - Comment Below)
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