New Patient Registration

If you are a new patient,  please submit the information requested below. We will check your insurance, and reply within 1-2 business days with appointment times. » Indicate which provider you would like to see, or choose “Undecided,” and we will help you choose the therapist that best suits your needs.

For more general inquiries or comments, please use our contact form.
  • Contact Information

  • If you partner is your contact, please type "Partner"
  • Insurance Information

  • Secondary Insurance Information

  • Service Information

  • Drop files here or
    Accepted file types: pdf, jpg, tiff, gif, png.
  • HIPAA COMPLIANT CORRESPONDENCE:

  • Thank you!

    When you submit this form, we will store your data/message in a secure & confidential fashion. Our clinic maintains HIPAA compliance.

After you submit your insurance, you may begin filling out our patient intake forms. We will check your coverage for you, and call within 1-2 business days to offer you an appointment.