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Crisis Line: 866-903-3787
Call: 988

Client Information

First name

Last name

Email address

Phone number

Age

Parent's Name (if request is for a minor)

I'm already a client

Date and Time

Day/Time Preference

Mondays 12:00 pm - 5:00 pm, Tuesdays 10:00 am - 5:00 pm, Wednesdays 9:00 am - 4:00 pm, Thursdays 8:00 am - 4:00 pm, Fridays (EMDR Intensives Only), Saturdays (Teen and Adult Clients with Joel or EMDR Intensives with Stacey)

About Your Appointment

Reason for Visit (Check all that apply)

Individual Therapy

Play Therapy

EMDR Therapy

EMDR Intensive

Therapy with Stacey (All Ages)

In-network with commercial Anthem BCBS (non-Medicaid/HMO), Optum, United Healthcare, UMR. Self-pay ($150 intake/$120 for 53-minute session). Offers Play Therapy, CBT, Mindfulness, EMDR, and EMDR Intensives. Mondays-Thursdays (Intensives Fridays-Sunday)

Therapy with Joel (teen-young adult) Saturdays and Self-Pay Only (will accept insurance in the near future)

In-network with commercial Anthem BCBS (non-Medicaid/HMO), Optum, United Healthcare, UMR. Self-pay ($150 intake/$120 for 53-minute session). Offers CBT, DBT, and EMDR. Saturdays and Limited Evenings)

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Reviving The Roots Counseling, LLC