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Request an Appointment
Full Name
(Required)
Email
(Required)
I am requesting an appointment for
(Required)
myself
someone else
If requesting an appointment for someone else, please provide their full name.
Driver's License or other form of ID for individual that will be receiving services
(Required)
Upload File
Front and Back of Insurance Card for individual that will be receiving services
(Required)
Upload File
Preferred Therapist
(Required)
No Preference
Galen McIntosh, LCSW
Jennifer Dixon, LCSW
Phyllis Leigh, LCSW
Stephanie Ruanto, LCSW
Lynn Thompson, LCSW
Stacie Sexton, CSW
My preferred time to meet is
(Required)
whenever. I am flexible.
before 12:00pm.
after 12:00pm.
after traditional business hours.
weekends.
The majority of our clinicians are providing services via telehealth ONLY. Are you okay with telehealth services?
(Required)
yes
no
Provide a brief description of what brings you here. Please include current stressors, symptomology, preferred treatment modality (if applicable), etc.
(Required)
Submit
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