Ready to begin?

Feel free to call us to schedule, or submit an initial appointment request. Please answer a few questions, and we will contact you shortly to schedule your first appointment. Hope Starts HERE.

Name*:

Phone Number*:

E-mail Address*:

Which therapist would you like to work with?*

Would you also like to work with Ashley Lewis for medication management?
NoYes

For whom are you requesting the appointment?
MyselfMy child

If appointment is for a child (age 17 or younger), please list legal guardian(s):

* *Please note only legal guardian(s) can schedule appointments for minors and give consent to treatment.

Briefly let us know what lead to your decision for therapy*:

Name of insurance company, if applicable:

Are you a GA Resident?*
YesNo

Are you a FL Resident?*
YesNo