Book Appointment Schedule your visit with ease and take the next step toward personalized, compassionate mental health care tailored to your needs. Please Fill out the Form below, and a staff member will reach out shortly to complete your Registration and Schedule your First Appointment First Name *Last Name *Preferred Name (optional)Email Address *Preferred Contact Number *Date Of Birth *Race (Optional)Select A ValueAmerican Indian or Alaska NativeAsianBlack or African AmericanWhiteHispanic or LatinoNative Hawaiian or Other Pacific IslanderUnknownEthnicity (optional)Select A ValueHispanic Or LatinoNot Hispanic Or LatinoGender Identity (optional)Select A ValueChoose not to discloseFemaleMaleFTM (Female-to-Male/Transgender Male/Trans Man)MTF (Male-to-Female/Transgender Female/Trans Woman)Genderqueer (neither exclusively male nor female)UnknownPronoun (optional)Select A ValueHeSheTheyUnknownPreferred Language (optional)Select A ValueEnglishSpanishOtherDeclined To AnswerStreet Address *City *State/Province *ZIP / Postal Code *InsuranceInsured ID NumberInsured Group Name/NoPersonal ID (Optional)ServiceSelect A ServicePsychotherapy NEW CLIENT: IndividualPsychotherapy NEW CLIENT: Family/Couples HollieWeight Loss: NEW PATIENT VisitConsent *I consent to the collection and use of my information for scheduling and care coordination purposes and acknowledge that this form does not establish a provider, patient relationship.Submit