Let’s work together

Please complete the form below. If there are openings at the time of your request, our Intake Coordinator, Valarie Dumont, will contact you within 2 business days.

If there are not any openings, you will automatically be added to our waitlist and can expect to receive email alerts every time new openings become available.

Information about our services and fees can be found here.

Looking for individual or group therapy?

Looking for psychiatry or medication management?

Insurance Policy for Couples Therapy

Unfortunately, we do not accept insurance for couple services. If you have in-network insurance, you will need to sign an insurance opt-out form prior to your first session.

Partner 1 Name

First Name

Last Name

Partner 1 Phone

(###)

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Partner 1 Email

Partner 1 Date of Birth

Partner 2 Name

First Name

Last Name

Partner 2 Phone

(###)

###

####

Partner 2 Email

Partner 2 Date of Birth

Type of appointment - check all that apply

Weekly Relationship/Couple Therapy

2-hour Consultation

Parenting Consultation

Intensive Therapy

Preferred Location

When choosing an individual therapist, please note that all providers offer teletherapy, and many also offer in-person sessions. If you only want teletherapy, please select Teletherapy ONLY. If you’re open to teletherapy or in-person, please select Teletherapy OR [Location] for the location you’d prefer if in-person is available. Please select one only:

Preferred Provider

Preferred days & times for weekly recurring sessions

Additional Information

Feel free to let us know your reasons for seeking therapy.

Your location (City & State)

Referral Source