Consultation Request

Whether you are new to counseling or new to working with our therapists, we require FREE 15-minute phone consultations for all new patients. During the consultation we will discuss your concerns and decide together how to help you achieve your goals.

You may request a free 15-minute phone consultation by completing the form below. Your request will be sent to an Advantia Health representative who will call you within 2 business days to assist in scheduling a phone consultation.

If you are a harm to yourself or others, call 911 or go to the nearest emergency room.

Name *
Name
Date of Birth *
Date of Birth
Gender *
Are you experiencing any of the following?
Please check all that apply.
Example: "trouble at work"
Phone *
Phone
Please provide the best number to reach you during the day.
May we leave a message? *
Please indicate whether we are able to leave a voice message if you are unavailable at the phone number you provided above.
How did you hear about us? *
Privacy Policy & Terms of Use *

Please print and complete the following assessments before your first appointment or consultation: