We're so glad you're here! Taking this first step toward support is a big deal, and we're honored to be part of your journey. To help us connect with you in the best way possible, please let us know who is completing this form. *

Individuals 18 years or older must complete their own intake paperwork and provide their own contact information (phone/email); if you are a family member or friend filling out this contact form on their behalf, please indicate so.

Self (18+ and providing own information)

Family Member or Friend

Name *

First Name

Last Name

Phone

(###)

###

####

Are you a new client? *

Yes

No

Would you like your visits submitted to insurance? *

Yes

No

Choose 1: *

By checking this box I consent to have my insurance benefits pulled for the purpose of an out of pocket estimate for services.

or I don’t need an estimate, I know my insurance benefits and I am ready to schedule.

Time of day that works best for you: *

We’ll do our best to honor your preference of morning, midday, or evening appointments. 🌟 Tip for getting matched quickly: The more flexible you are with your availability, the better chance we have of pairing you with the right therapist. Late afternoon and evening sessions fill up fastest, so if you’re also open to mornings or mid-day, please let us know. Our goal is to get you started with the right support as soon as possible, sharing flexibility helps us make that happen.

Morning

Midday

Evening

Weekend

Do you have a gender preference for your therapist? *

While we currently do not have any gender expansive or nonbinary therapists on our team, all of our providers are trans-affirming. If we add gender expansive clinicians in the future, we’ll be sure to include them in our options.

Male

Female

Either/No Preference