Your Relationship to Client
Note: You must have legal authority for medical authorization to schedule an appointment for a minor. If the client is an adult you must have the client's expressed permission to schedule an appointment.
Preferred Therapist (if any).
Note: Due to staff schedules, we can't guarantee availability of a given staff person, but one of our therapy staff will reach out.
Note: During the school year we attempt to limit evening appointments to elementary, middle and high school students
Type of Service You're Seeking.
Please don't leave this blank. We need this information to assign your case.
Provide a detailed summary of what brings you or your child to see us.