Please complete the Intake Form below in full.  Once your form has been submitted, we will be in touch within 1 business day (Monday-Friday) to reserve your appointment.

We look forward to connecting with you soon!

Contact Information
Name *
Date of Birth *
Date of Birth
Phone *
Can we leave messages at this number? *
Our Client Care Specialists are available Monday-Friday from 10 a.m.- 6 p.m.
Address *
1 being "I couldn't be less concerned/the concerns don't bother me" and 10 being "I couldn't be more concerned"
If "Yes", when?
If you're working with multiple helping professionals, please select the most recent.
If "Yes", what other helping professionals have you worked with related to these concerns?
Please check all that apply
Scheduling Appointments
What days are you available for appointments? *
Please check all that apply
What times are you available for appointments? *
Please check all that apply
How do you wish to receive appointment reminders? *
Reminders are sent 48 hours before your scheduled appointment
We will do our best to match you with your preferred therapist, taking into account your concerns, availability, and therapist availability (note: some of our therapists currently have waiting lists).
Online couple's therapy is a convenient, discrete way to access our high-quality services.
Please ensure to check with your insurance provider to confirm the details of your coverage prior to your first session. You can refer to our "Guide To Understanding Your Insurance Coverage" through our "Services" page for more information!
A credit card number is required to reserve appointment times. We kindly ask that you have a credit card ready when we contact you to reserve your appointment. *