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 ASAP, but can take up to 48 business hours.

Please correct the errors described below.

Currently, Molly Dalva, Mallory White, and Jess Faulkenberry are not able to accept new patients. Bill Mulkey is accepting new patients on a limited, case-by-case basis.

If you require a female counselor, choose it below and you will be emailed a list of female providers in our extended group that accept the patient's insurance/payment needs.

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.

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