First, can we acknowledge you for taking this important step toward your best self? Nice work!
You can use this form to ask a quick question about services with us. Or, if you are ready to begin services please complete the entire form. Your information will be encrypted and sent to us securely.
This form may not be reviewed immediately but we absolutely will reach back out to you within a few business days. If you are having in crisis or need immediate assistance for your safety, please do not wait for our reply. Your safety comes first -- call 911 or go to an emergency room.
If you prefer, you can call the office to ask your question or complete this initial screening with a front office team member. Call 419-537-0900, ext 100 Monday – Thursday during business day.
Note: If you are completing this form for someone other than yourself, make sure they know about it. Give their details not yours.
Please take photos of your insurance card(s) and upload below.
Your information will be encrypted.