Availability Form

This form is designed for new clients who have already scheduled their Initial Intake Appointment. Please complete this confidential form and we will follow up with you within two business days. Thank you!

Client Full Name

Client/Parent/Gaurdian Phone Number

Parent/Gaurdian Full Name, if minor

Client/Parent/Gaurdian Email Address

Please provide a brief description as to why you are seeking counseling services.

Please provide the ALL the days/times for you are available to participate in counseling.

Would you prefer in person or telehealth appintments?

In Person

Telehealth

No Preference

Providers

Please check ALL of the providers that you would fit your needs. You can learn more about all providers by clicking the links below:

Shaterra Walker, Licensed Professional Counselor

Hannah Einstein, Licensed Professional Counselor

Tameesha Curry, Resident in Counseling

Jessie McGlothlin, Licensed Professional Counselor

Chandra Shorter, Licensed Professional Counselor

Nijeria Jones, Licensed Professional Counselor

Lauren Rutledge, Resident in Counseling

Maura Lesko, Licensed Professional Counselor

Pragya Agarwal, Resident in Counseling

Thank you for completing this form. We have a high volume of requests and strive to respond to all requests for services within 2 business day. Thank you!

Availability Form

This form is designed for new clients who have already scheduled their Initial Intake Appointment. Please complete this confidential form and we will follow up with you within two business days. Thank you!

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