**IF THIS IS AN EMERGENCY, PLEASE CALL 911 OR GO TO YOUR LOCAL EMERGENCY ROOM. National Suicide Prevention Lifeline: 988CONTACT Name * First Name Last Name Email * Phone * (###) ### #### Why are you seeking therapy? Please provide a brief description. * Name of insurance * Do you have Medicare? * Yes No Do you have Medicaid? * yes no Preferred method of contact * Phone Email-may come through an encrypted email (Hushmail) to protect your information. Please be sure to check your junk/spam folder. Thank you for reaching out. Please know that we have received your inquiry and will contact you within the next 48 hours.
