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What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other (please specify below)

What kind of care is being sought?

Individual Psychotherapy Family Psychotherapy Couples Psychotherapy I'm Not Sure

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently (in the last year) Hospitalized for mental health reasons in the past (more than a year ago) Attempted suicide in the past None of these apply

Additional Details

Please share how you're hoping we can support you.

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Earliest Start Date

When would you like to start your care with us?

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