Age Verification *

You must be at least 18 years of age to request an appointment. If you are under 18, please have your legal guardian contact us.

I am at least 18 years old.

I am a parent or guardian requesting an appointment for a minor.

Client's Name *

First Name

Last Name

Parent/Guardian's Name (if applicable)

First Name

Last Name

Phone *

(###)

###

####

How do you prefer we contact you about this? *

Please check all that apply.

Call me

Text me

Email me

What services are you looking for? *

Counseling (therapy)

Psychiatry (medication)

Both

Which issue(s) would you like help with? *

Please check all that apply.

Anxiety/Panic

Depression

Trauma/PTSD

ADHD

OCD

Couples/Family Issues

Other

Insurance *

WE DO NOT ACCEPT MEDICAID, MEDICARE, MO HEALTHNET, OR COMMUNITY PLAN.

I'm not using insurance at all, so I will pay out-of-pocket.

I have United Healthcare, UMR, Golden Rule, All Savers, Medica or GEHA.

I have other insurance, and I want paperwork to file claims myself.

In-Person vs Telehealth *

You have the option to have your appointment in-person or online. Which do you prefer?

Telehealth Online

In Office

Either

What is your preferred location? (Optional: if you selected in office)

Columbia

Jefferson City

Do you have a strong preference for a female or male therapist? (Optional)

Female

Male

Either is fine

I agree *

By clicking "Submit" below, you understand that email is not a secure form of communication. Please allow us a few business days to get back to you. We DO NOT accept any form of Medicaid, Medicare, Community Plan, or MO HealthNet. If this is an emergency, please call 9-1-1.

Yes, I agree!