INTAKE FORM

If you are making a referral, please use the client's name and your email address.

For psychological evaluation referrals, please fill out our psychological evaluations intake form here.

Please Note: We currently do not have availability for Psychotherapy services under the following primary insurances: Blue Shield Promise, CHG, BetterHealth, and Medicaid. If any of these are secondary insurances, they are accepted.




Please enter CLIENT's Name and YOUR Email

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