Appointments

To schedule an appointment, click on an available time. If you don’t have an account, you’ll need to create one. Don’t worry, it’s free and easy. You’ll receive a confirmation e-mail, however due to a glitch in the system, please ignore the location stated in the e-mail. After scheduling your appointment, please fill out the bottom portion and send. All information you provide is completely confidential.

Client Name
Address
Cell Phone Number
Home or Work Number
E-mail
Date of Birth
Insurance Co.
Policy #
Phone # on back of card
Name of Policy Holder
Date of Birth of Policy Holder
Number of Visits Authorized
Co-Pay
Previous therapy?
Currently taking any medications, if so then what?
How were you referred to this practice?
What is your most pressing issue?