New Client Request

Existing clients: please contact us at 813-254-3200 or [email protected] for assistance.

First Name *

Last Name *

Email *

Phone *

Office Location *

Counselor *

Treatment Preferences *

Accelerated Resolution Therapy (ART)

Cognitive Behavioral Therapy (CBT)

Emotionally Focused Therapy for Couples (EFT)

Eye Movement Desensitization and Reprocessing (EMDR)

Gottman Method (Couples)

Play Therapy (for children)

Unsure/No preference

Service Type *

Counselor Preference *

Any Additional Info

Urgency of Care *

Can wait for preferred counselor match

Need earliest available appointment

How did you hear about us? *

Acknowledgment *

I understand this is not a crisis service and should call 988 or 911 for emergencies

Messaging Consent *

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