New CLients

 

If you are interested in becoming a new client, please complete the form below. The information provided will allow us to learn about you and your needs. You will be contacted and an appointment may be scheduled. You’re encouraged to call or email to confirm that we are accepting new clients before submitting this form.

 
Legal Name *
Legal Name
Please specify if you have insurance not listed above or if you plan to decline using insurance to cover the cost of services.
Providing this information allows us to verify your benefits prior to your first visit.