Request an Appointment Please complete the form below to request an appointment. I will review your information and respond within 1-2 business days.Name(Required) First Last Email(Required) Phone Number(Required)Date of Birth(Required) MM slash DD slash YYYY What state are you currently in?(Required)GeorgiaOtherThird ChoiceIf other, please list your state:(Required)What times are you generally available?(Required) Morning (8am-12pm) Afternoon (12pm-4pm) Evening (4pm-7pm) How do you plan to pay for services?(Required) I plan to use insurance I prefer private pay I'm not sure yet Insurance benefits will be verified prior to scheduling.Private pay appointments are available for clients seeking greater flexibility, privacy, or specialized services such as walk-and-talk sessions.What brings you to therapy at this time?(Required)Please select any areas you are experiencing: Anxiety Depression Relationship concerns Life transitions Stress/overwhelm Trauma What are you looking to get out of therapy?Are you currently in crisis or in need of immediate support?(Required) Yes No If you are in immediate distress, please call or text 988 or go to you nearest emergency room. This form is not monitored continuously.Consent(Required) I understand that submitting this form does not guarantee an appointment and that insurance will be verified prior to scheduling.
