This form is reserved for those who wish to schedule their initial counseling appointment with us. If you simply have questions, please contact us by phone.

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In case of an emergency, please dial 911 or get to a hospital emergency room.

The preferred option is for you to call us at 888.200.9746. However, if it is more convenient for you, you can complete and submit the form on the right. We will call you within 24-48 hours during your selected timeframe to begin the intake process with you.

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For confidentiality purposes, please provide us with a non-work (cell or home) phone number, if possible. Thank you!

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