Request an Appointment

This request does not imply a therapeutic relationship. If this is an emergency, call:

NOTE: If you are NOT using insurance, please schedule here.

Existing clients can reschedule here.

Client Information

First name

Last name

Email address

Phone number

Date of Birth

State of Residence

We serve only Michigan residents

Insurance Plan

We ONLY accept: Blue Cross Blue Shield (no Blue Care Network) and McLaren (commercial only) **MEDICAID NOT ACCEPTED**

Insurance Member ID

Policy Holder's Name

Policy Holder's DOB

mm/dd/yyyy

Depression/Anxiety

Stress/Burnout

Motherhood/ Post Partum Issues

LGBTQ Issues

Grief

Trauma

Marital/Couples

What are your goals for therapy?

Please tell us a bit about what brings you in and/or your goals for therapy

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