New Patient Inquiry

Let's start your journey.

Please submit a message, and our clerical team will call you back to get started.

This form is best viewed/completed on a computer or tablet.

 

In the text box below, please include:

1) The reasons for seeking counseling

2) Insurance information

3) Requests for a specific provider

4) Your available days/times for therapy

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Our clerical team may request additional information through our prescreening questionnaire. This request will come from "yourprovider@simplepractice.com" and will direct you to our patient portal. Please complete this additional questionnaire as soon as possible.

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Once we have assigned you a provider and an appointment time, you will need to complete some additional intake documentation at least 24 hours before your first appointment.

You can also call our office (Monday-Thursday 9-5; Friday 9-4) -- (785) 776-4105