top of page
Client Portal
Contact
Home
Services
Assessment
Psychotherapy
BICS: Brain Injury Coping Skills Group
Independent Educational Evaluation (IEE)
Worker's Compensation
Forensic/Legal Evaluations
Vocational Rehabilitation
Team
Insurance
FAQ
Resources
Appointment Request
Careers
More
Use tab to navigate through the menu items.
If you are a current patient please do not fill the form below and instead
Click Here
Request an Appointment
Patient Name
Patient Date of Birth
Policy Holder Name and DOB (MM/DD/YYYY)
Email
Phone
Health Insurance
Insurance ID
Services
Neuropsychological Evaluation
Therapy
Worker's Compensation
Legal/Forensic Services
Other
Brief Message (Please indicate reason for appointment request. Please indicate the contact person and their relationship to the patient listed above)
I acknowledge and accept the potential privacy risks of communicating health information via this unencrypted email and messaging. I agree to share protected health information via this electronic means.
Submit
Thanks for submitting!
bottom of page
