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Client Intake Form

Please fill out the following form to help us understand your mental health needs so that we can match you with one of our mental health professionals.

Will you be paying for services out of pocket or using insurance?
Select the therapist(s) you would like to work wih Required

Thanks for submitting!

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties. 

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By providing a telephone number and submitting the form, you are consenting to be contacted by SMS text message. Message & data rates may apply. Reply STOP to opt out of further messaging.

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For more information on our Privacy Policy, click HERE

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