Contact Form
If you are planning to use insurance:
If you are planning to self-pay:
  • If you are interested in becoming a client or have other inquiries for one of our clinical therapists, please complete this form. We will contact you within 2 business days with more information via the email address you provide.

​
Name and/or preferred name Pronouns Date of birth State of permanent residence E-mail Phone number
Which clinical therapist are you interested in working with (select all that apply)?
Dr. Anna Stewart (she/her)
Dr. Kendall Coffman (he/him)
No preference
What service are you interested in (select all that apply)?
Individual therapy
Couples/relationship therapy
Therapy/support group
Clinical supervision (Marriage and Family Therapy, MFT)
Clinical supervision (Social Work, LSW)
Other
How do you plan to pay for therapy sessions?
Insurance
Out of pocket
Unsure
What led you to seek services/reach out?
How would you like to be contacted?
Phone
Email
Submit