Request an Appointment

Thank you for reaching out to us. Please complete the form below and someone from our team will contact you within 1-2 business days to match you with one of our providers.

I am a:

Potential new client

Returning client

Family member of a current client

Adult seeking services on behalf of a minor

Curious person just wanting to be added to email list for future offerings

Other

First name*

Last name*

Email*

Phone*

Is it OK to leave a voicemail message?

Yes

Other

Birthday*

Month

Day

Year

Age of person seeking services:

If referred by another professional, what is their name?

Preference for service

In-person

Virtual/Telehealth

No Preference

Which therapist would you like to see?

Dr. Leslie Bottoms, PhD, LPC-S (new clients will be waitlisted)

Shawntay Fenyo Woods, LPC, PhD

Tammy Folaron, LCSW

Detrich Anderson, LPC

No preference

Please leave a brief message about your needs.*

Upload FRONT of insurance card*

Upload BACK of insurance card*

Reminder: This is only a request for an initial appointment and does not guarantee an appointment, nor does this establish a therapist-client relationship.

We will review the information you have provided to determine if we have a therapist available who would be a good fit for you.

Would you like to be added to the newsletter?*

Yes, add me to the newsletter.

No, do not add me to the newsletter.

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