Skip to content
Home
Services
Our Team
New Clients
Contact
Fax 517-750-3673
517-750-3869
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Are you seeking services for yourself or someone else?
*
Myself
Someone else
Name of person inquiring:
*
First
Last
Name of new client:
*
First
Last
Age of new client:
*
4-11 years
12-18 years
18 years and up
Telephone number:
*
Email:
*
Desired service:
*
Individual therapy
Couples therapy
Psychological evaluation
Availability for appointments:
*
Open/flexible
Mornings only 9am-12pm
Afternoons only 12pm-4pm
Evenings only 4pm-7pm
Therapist preference:
*
First available/best fit
Female
Male
It’s our goal to match you with a therapist according to your preferences, however it is subject to availability and scheduling constraints.
Insurance provider: of
Specific therapist request:
If there is a specific therapist you wish to work with, please type their name here.
Session type preference :
*
In-person sessions only
Telehealth sessions only
In-person or telehealth sessions
Telehealth visits are conducted via telephone or online video call. We have multiple therapists who only offer telehealth sessions.
Insurance provider:
*
Brief description of what you are seeking services for:
This information helps us to make the best match for you keeping your needs in mind with our individual therapists’ abilities.
Additional comments:
Submit
Home
Services
Our Team
New Clients
Contact