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*:

    Please select which office location you’d prefer*:

    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