UCA Appointment Request

If you have an emergency, dial 911. If you are having a mental health crisis, call 800-273-8255. All prospective new patients, and referrals, please complete the below form. If we are unable to schedule you with one of our counselors, you will be provided a list of trusted providers we work with, that accept your insurance/payment needs. We will be in contact via email as soon as we are able to process your request.

Please correct the errors described below.

Maggie Eilts and Brittain Bass are our only available counselors at this time.

Maggie has availability at 1:00 and 2:00 on Mondays, and 1:00 on Tuesdays.

Brittain has availability Mondays or Wednesdays at 2:00.

Please include any past diagnoses here.
If you have a specific therapy method (EMDR, etc.) you are interested in, please indicate it here.

Any information included on this form, is sent to us via a HIPAA-compliant encryption software, and treated with the utmost confidentiality.

Your information will be encrypted.