Appointment Request


Please fill out the form below or give us a call at 614.818.4099 if you are interested in scheduling an appointment.  Please include the name of your primary insurance carrier if you plan to submit counseling services.  This information assists us in determining the in-network or out-of-network status of our counselors.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.


Start your new path in life and be the change today!

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Helpful Forms

Click here to view and print forms for your appointment.

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