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Request an Appointment

Complete the Registration Form  below to request an appointment.  Please allow 24 to 48 business hours  (Monday-Thursday) for us to contact you.  

Please have the following information available to complete the forms. If you do not have the information at this time, call the office to receive a link to the Patient Portal and complete the information there. You will be able to save and return to the Patient Portal at a later time.

  1. Primary Care Provider (PCP) contact information.(phone number, address)

  2. Counselor's contact information

  3. Insurance Card

  4. ID card 

  5. Medications

  6. Pharmacy Name and Phone number

  7. Contact information and fax number for any providers or individuals that you wish to release your information to.

Complete BOTH the registration forms and upload  your insurance cards and identification cards.

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