Waitlist Request Form
We are a small, part-time practice with high demand for services. Thank you in advance for your understanding.
We are a small, part-time practice with high demand for services. Thank you in advance for your understanding.
Information submitted through this form is transmitted using secure, encrypted systems and will be used solely for the purpose of responding to your appointment request. Please do not include highly sensitive clinical details, emergency information, or urgent mental health concerns in this form. Submission of this request does not establish a therapist–client relationship. If you are experiencing an emergency, call 911 or go to the nearest emergency room. For information about how your protected health information may be used and disclosed, please review our Notice of Privacy Practices.