Appointment Request

To schedule a therapy appointment or receive additional information about any of our counseling services, please fill out the form below or call us. Our office can be reached at 276-870-0917

PLEASE NOTE THAT ALL REQUIRED PAPERWORK MUST BE COMPLETED BEFORE THE APPOINTMENT TIME. YOU WILL BE CONTACTED BEFORE YOUR SESSION WITH ADDITIONAL QUESTIONS AND INSTRUCTIONS.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form on this website. This form is for general questions or messages to the practitioner.