complete and send this form in order to:

• Schedule your First Session.

• Schedule your Next Appointment.

• Book a Booster Session or Resume after being away.

• Contact us for other reasons! For example, to refer a friend, cancel/reschedule existing appointment, ask to be removed from our email list, or tell us how we can serve you better! Let us know what you need!

Our intake coordinator will follow up with you by phone/email shortly!