top of page

Our waitlists is open for individual, family and group therapy. Please fill out the form below and we will be in contact to get the process started. TM referrals can be made by Hubs, please reach out to and request a referral form.

To register for services please email us the following information pertaining to your health insurance at our secure email

  • Insurance Plan Name:

  • Insurance Number on the card:

  • Name of Main Subscriber:

  • DOB of Main Subscriber:

Please submit the information below, If something does not pertain to you on this form please indicate N/A:

List services are you interested in:
Preferred Therapy Modality
Do you Prefer In-person or Virtual therapy appointment?

Thanks for submitting!

bottom of page