Appointment Request Form

This form is used for new prospect clients and returning clients to request an appointment to make scheduling easy and effortless!  This pertinent form let's us gather basic client contact information, insurance information, and it is used to briefly identify the reasons a client is interested in counseling. This helps us to streamline registering you as a new client or returning client and to promptly verify your Mental Health benefits. 

What happens next? 

Upon receipt of your APPOINTMENT REQUEST FORM, we will promptly review you submission and verify your insurance eligibility.  This process is normally completed same business day - but in some cases, may take up to two business days to complete.  Simply Reply back "C" to Welcome Message with Courtesy Benefits Quote to Confirm Appointment. 

Thank you,

The Pink Positive Psychology Team

đź”—LinkTree Link:

*Returning clients are previous clients that have not been seen for more than 2-months.

*This form is HIPPA compliant and ENCRYPTED which means your information is safe and secure.