Request an Initial Appointment
We are here for your mental health journey! Please complete this form if you are looking to request an initial appointment or receive more information about our services. Our caring intake staff respond to inquiries during business hours.

General Information

Services Requested

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 sensitive information with unknown third-party entities or use it for purposes outside of intake and scheduling.