Good Mess Wait List Inquiry
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Thank you for reaching out about the waitlist! We will do our best to get back to you within 1-2 weeks and discuss next steps. There is a limit of 3 people on the waitlist at a time to ensure timely responses. We will actively communicate if spots open, and if 6 weeks have passed without, we will let you know ASAP and provide alternative providers to reach out to- to ensure your needs get met in a timely fashion. Hours of operation are Monday- Thursday, 10am-7:15pm.
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Client's Name *
Client's Date Of Birth (mm/dd/yyyy) *
Client's Gender + Pronouns
 *
Email Address and Phone Number (of parents if client is a minor) *
Home Address
If under 18 y/o, please list client's grade and current school
If under 18 years old- what are the Parent's Name(s)
Brief synopsis of challenges needing be addressed *
Type of Session Preference 
Clear selection
Session DAY and TIME Preferences  
 (please note- more opportunity when larger windows provided;  i.e. Tuesdays + Thursdays 3-7)
 *
Client's Insurance *
Please let us know how you heard about us! *
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