Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

MM

DD

YYYY

Time of Day Preference *

Please note: We do not have openings for appointments after 4 pm.

Mornings

Afternoons (12-4 pm)

No Preference

Preference for meeting *

Virtual Sessions

In-Person Sessions

Outdoor Sessions (Walk & Talk)

No Preference

Do you have a preference for a therapist? *

Our wait list for therapy is approx. 3-4 weeks (depending upon which therapist you would like to see) & 2-3 months for couples therapy. Please note our current limitations at the top of the page. If you do not see a clinician's name on the list, it means they are currently not taking new clients. Please note that we prioritize those seeking specialty services for perinatal/reproductive difficulties.

First Available

Ashley M. (virtual only)

Britnie

Elyse

Joey (18+ only)

Jamie

Kayla

Kate R. (18+ only)

Katy S.

Mary-Rose

Mira

Rachel

Ryan (18+ only)

Samantha

Sarah

Shannon (virtual only)

Not needing a therapist at this time

Are you interested in meeting with our Psychiatric Nurse Practitioner for a medication evaluation (pregnant or postpartum related only)?

**note: currently not working with clients in need of ADHD medication management or evaluation.

Yes

No

If you are interested in being contacted about our additional services that are billable to insurance, please check below and you will be contacted by the appropriate clincian:

Skills Group for Pregnant/Postpartum Moms (Shannon Wohlman)

Substance Use Recovery Group for Pregnant/Postpartum Moms (Rachel Barr)

Acupuncture (Carolyn or Alisha)

Pelvic Floor Occupational Therapy (Megan Miller)

Pregnancy/Postpartum Occupational Therapy (Megan Miller)

If you are interested in being contacted about our additional services that are NOT billable to insurance, please check below and you will be contacted by the appropriate clinician. All services are described on our website:

Relaxation, Swedish or Trigger Point Massage, 60 or 90 min (Jocelyn Swanson or Heather Gariepy)

Prenatal Massage (Jocelyn Swanson or Heather Gariepy)

QNRT (Katy Johncox)

Parent/Caregiver Coaching (Megan Miller)

ART Intensive (Chelsea Brumme)