Contact Us

Name *

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Email *

May we add you to our email list?

Phone Number *

What Type of Therapy Services Are You Seeking? *

You may select any or all options.

Which DBT skills group are you interested in? *

Please tell us your child's age. *

Please indicate your custody status: *

What is your child's level of willingness to engage in therapy? *

What, if any, safety risks are you concerned about? *

If you or you child are in imminent risk, please call 988 or go to your local crisis center.

What, if any, treatment have you already received? *

Please describe any current or recent services including outpatient therapy, psychiatry, IOP, PHP, or hospitalizations.

Please provide any additional infomation you'd like us to have. *

What are you hoping to achieve through therapy?

When is the best time to reach you? *

Do you have a preference of location for services? *

You may select any or all options. If you want first available, please select all.

What state do you live in? *

For telehealth appointments, we must match you with a clinician licensed in your state.

All Inquiring Clients Must Submit This Inquiry Form