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Appointment Request Form

Thank you for contacting Therapy Changes Lives. We appreciate your interest in our practice and the trust you've placed in us by reaching out. While our practice is accepting new patients, not all requests may result in an appointment, as our priority is to ensure the best fit for both patient and provider.

We offer new potential clients an initial intake that ascertains what concerns you are navigating. There are times when the practice focus, session availability/frequency needs or level of crisis is not suitable for our practice. Our priority is to ensure each client receives the appropriate level of care; and, in some cases, this means recommending that you connect with a provider who can better match your specific needs and circumstances (e.g. specializing in medicine management, group therapy services, and longer/more frequent in-person appointment options).

Thank you again for considering Therapy Changes Lives for your mental health needs!

If you are or believe you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thinking, side effects to medication, or any other urgent or time-sensitive matter in which you need an immediate response, do not use this service. Instead call 911 or go to your closest emergency room.

Patient Intake Form (#3)

Medical History