COMPLETE FORMS, SCROLL DOWN TO MAKE APPOINTMENT AND PAYMENT

Your appointment will be cancelled without completed forms.

NO OTHER TIMES ARE OFFERED PLEASE SCHEDULE ONLINE AND PAY

 

REQUIRED FORMS FOR SERVICES

Click to Complete Before Appointment

STEP ONE: CONSENT FOR SERVICES & PRIVACY NOTICE

REQUIRED WITH STEP ONE IF APPLICABLE:

DOMESTIC VIOLENCE ANGER MANAGEMENT ENROLLMENT AGREEMENT

STEP TWO: INTAKE QUESTIONNAIRE FOR MY ASSESSMENT APPOINTMENT

 

Our Services

 
Therapy Session

SLIDING SCALE APPLICATION REQUEST

Income Information Will Be Requested for Verification.

If you are eligible for Indiana Medicaid a provider will assist you with the application.

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