Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

It is recommended to use a laptop to fill out forms. Please complete in full with accurate information. We will review together during the initial session. All participants in marriage and couples or family sessions must first attend an initial individual session to complete intake. All sessions are private pay, a card must be filed in order to schedule your sessions.

Client Information

/ Middle Initial

( optional )
 


( optional )
( optional )





( for Text Message Reminders )


(optional) (required)

Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers