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Name

First Name

Last Name

Phone

(###)

###

####

Client's Date of Birth

Type of Therapy Needed

Preferred Therapist - Subject to Fit & Availability

Preferred Format

Insurance Provider

Currently No Medicaid Plans Accepted

How did you hear about us?

Message

Are there times during the week that don't work at all for therapy? Times that work really well? Feel free to share more about what you want in a new therapist. This information helps us get you connected with the best fit possible. Thanks!

Office Location:

30 Jefferson Ave SE

Grand Rapids MI 49503

Current Standard Rate: $185

Schedule a Session

Reach out today!

Let’s figure it out.