Looking to schedule an appointment? We're here for your mental health journey.Please complete this form if you are looking to schedule an initial appointment or receive more information about our services. Our caring staff will respond to inquiries during operating hours, within one business day.Please enable JavaScript in your browser to complete this form.Client Name *FirstLastEmail *Phone Number *Seeking *Individual TherapyFamily TherapyPsychological TestingNeuropsychological TestingMedication ManagementOtherMessageName of Individual ReferringFirstLastThis person may be a healthcare professional, school administrator, parent/guardian, or any individual who is completing the form on behalf of the client. Relationship to ClientHIPAA Acknowledgement *I understand and agree to the information below.Clients have certain rights to privacy regarding their protected health information under the HIPAA Act. By checking the box above and submitting this form, the client is acknowledging that they may voluntarily be sharing sensitive information with our practice. While Responsive Centers cannot guarantee confidentially, we will never share any personal information with third parties or use it for purposes outside of scheduling and intake.Submit
