New Client Form

Winter Retreat and Group Registration is live

Hi there,

Thanks for reaching out, our practice is currently at capacity and we are unable to take on new clients at this time. We should start taking new clients in December and we will have an additional male therapist starting in January.

You are welcome to still complete this form if you would like to be placed on the wait-list and we will reach out as spots open up. We also have two alternative means to get some good work done outside of traditional therapy:

Our 2nd Annual Winter Nervous System Retreat will be on 1/16-1/18 in Jackson, MI, check it out here.

We also have our eight-week, Winter Men's Group starting at the end of January, check it out here.

Take care,

Mike

First name

Last name

Date of birth

Cell phone number

Email address

What brings you to therapy/what are your current biggest concerns?

How would you like to meet? Our in-person office is in Royal Oak, MI, Monday-Saturday

In-person only

Video/Online only

Hybrid/Mix of both

I am also interested in men’s group and/or retreats

When are your preferred times to meet? (Select all that apply)

Mornings

Afternoons

Evenings

Therapy History

Have you been in therapy in the last 12 months?

Yes No

Were you referred by someone? if yes, please share their name/organization below:

May I add you to our quarterly newsletter?

Yes No thanks

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New Client Form

Winter Retreat and Group Registration is live

Winter Retreat and Group Registration is live

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