Modal Form: Appointment Request | Eating & Behavioral Health

If you want to see a specific clinician, click here to see if they are available and schedule directly through the ClientSecure portal.

If you do not have a specific clinician in mind or they are not available, please fill out the form below to be scheduled with a clinician who fits your needs.

I am scheduling for: *

Contact First Name *

Contact Last Name *

Email *

Phone Number *

Date of birth *

My insurance is: *

I am interested in scheduling with: *

What is your concern?

I am interested in:

In-Person

Telehealth

Either

I was referred by:

Please note: information sent via contact form is not secure, therefore exercise caution with any sensitive information. Do not use form for emergencies or highly confidential information.

Thank you for taking the first step in getting help. We will reach out to you in 24-48 hrs after receiving your request to start the scheduling process.

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