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Seeking Services?

We can help! Fill out this form and we'll get back to you on seeing one of our clinicians. 

Service Request Form

What services are being requested?
Who is in need of services?
Are there currently any legal or school involvment with the child/family?
Are you willing to place a Release of Information on file?
Select your preferred location:
Is there a request for financial hardship support (e.g. seeing an intern at a lower hourly rate)?
How will services be paid?
Select the days you are available for scheduling
Select the time frame that best works for scheduling

Thanks for submitting! Once we've reviewed your information, we will be reaching out to aid in scheduling your appointment. If we need further information, we will reach out to you via email. Please allow 24-48 hours for us to review your case.

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