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Preferred Therapist: *

*Please be advised, your requested therapist may not have availability.

Do you plan to utilize your Employer's EAP benefits (Employee Assistance Program)? *

Yes No

*We generally do not accept EAP, so please check with the office first.

*Please be advised, we do not accept Medicaid/Medicare/Soonercare plans at this time.

Are you wanting couples/marriage/family counseling? If so, please provide first & last names of all individuals who will be present for sessions: *

*Please be advised, we do not bill insurance for marriage or couples counseling. It is $180 per session.

Please list email addresses for all individuals that will be present for sessions (everyone present must sign consents prior to scheduling): *

Are you involved in an open court case, i.e. divorce, custody hearing, DHS case, etc? Please describe: *

*Please be advised, our therapists may not be available for court appearance. Additional reporting fees may apply.

Once you click submit, your form will be sent to us and someone from our staff will set you up on our secure client portal as soon as possible.
Look for an email from us with a link to the portal.

After you have filled out all the required info and signed the consent forms in the client portal, we can schedule your first appointment. Someone from the office will reach out to you.

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