For new clients, please describe what is bringing you in for an appointment. If you have a mental health diagnosis or other health concern we should be aware of, please mention it here. For current clients, please include what provider you would like to make your appointment with, as well as any other information you would like to share.
If are thinking of hurting yourself or someone else, we want to help you right away! Please call us:
Florida (toll-free): 941.782.4617
Illinois (toll-free): 855.985.0911
Indiana (toll-free): 800.832.5442
Tennessee (toll-free): 800.681.7444
National Suicide Prevention Lifeline (toll-free): 800.273.8255
Or, enter your zip code below and we will suggest a location:
Your privacy is deeply important to us. This form is secure so that only our call center staff will see the information provided, and they will only use it to schedule your appointment. Click here to learn more about our privacy practices.