New Client Appointment Request Form

We currently have the following availability to accept new patients:

  • In-person, daytime appointments in the Westfield, Springfield, and Maywood offices for teens (ages 14+) and adults (but nothing open after school)
  • Virtual appointments for adults daytime and evening
  • Only Individual Therapy is available at this time (our couples and family therapists are full)
  • Weekends (daytime in Maywood only; for adult clients only)
  • Biofeedback daytime and Sunday available
We plan to add in-person evening availability soon, together with in-person availability in Little Falls, as well as child therapists.
Most answers below are required so we can properly review your request and attempt to secure an appointment with one of our therapists. After filling out the form, we will follow up with you, via e-mail or phone, within 1-2 business days.
(FOR OFFICE USE ONLY)
(Legal name, as your insurer would have it)
Parent, spouse, partner, aunt, uncle, cousin, friend...

How can we help?

Most answers are required so we can better understand how best to assist you.
(i.e. who needs the treatment, background, current issues...)

Payment/Insurance Information

Click or drag files to this area to upload. You can upload up to 2 files.
.PNG, .JPG, .DOC, or .PDF Format Only
Click or drag files to this area to upload. You can upload up to 2 files.
.PNG, .JPG, .DOC, or .PDF Format Only