Intake Request Form

Please complete the form below to request services and we’ll be in touch within the week.

Currently Accepting New Clients

• We do not accept any form of Medicare or Medicaid at this time.

IMPORTANT NOTICE: This form is not intended for urgent matters and will not be read immediately.

For urgent assistance:

• Dial 988 for the National Suicide and Crisis Lifeline.

• Dial 911 for emergency services or go to the nearest emergency room.

• Warm lines (no police intervention): https://www.inclusivetherapists.com/crisis