Join Our Waitlist

Join Our Waitlist

Please fill out this form and will add you to our waitlist and get you scheduled as soon as possible. Thank for your patience!
Client Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Address

Street Address

Street Address Line 2

City State

Zip Code
Date of Birth

Month Day Year
Health Insurance Carrier

NONE Aetna Anthem - BCBS Kaiser Permanente / Beacon BIND Cigna/Evernorth Continental Benefits GEHA Medicaid UnitedHealthcare - Optum UnitedHealthcare - Allsavers UMR Tricare Other
Insurance Carrier
Member ID # *
What service are you looking for? *

Children (3-5) Counseling Elementary (6-10) Counseling Preteen (11-13) Counseling Adolescents (14-17) Counseling Adult Counseling Geriatric (65+) Counseling Marriage / Couples Counseling Family Counseling Psychiatry Psychological Evaluations
Parent/Guardian Name *

First Name Last Name
Desired Counselor Specialty *

Anxiety ADHD Behavioral Issues Addiction Bipolar Disorder Alcohol Use Depression Anger Management Divorce Antisocial Personality Eating Disorders Infidelity Marital and Premarital Medication Management Faith Issues Parenting Relationship Issues Self-Harming Stress Substance Use Suicidal Ideation Transgender Trauma and PTSD Spirituality School Issues Obsessive-Compulsive (OCD) Domestic Abuse Other
Best Day For An Appointment *

Any Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Best Timeframe For An Appointment *

Any time of day Morning Afternoon Evening Other
Preferred Provider (optional)
Preferred Office/Location *

Telehealth (virtual) CS - Erindale Dr Office CS - Academy Cir Office CS - Circle Dr Office CS - Centennial Blvd Office CS - Barnes Rd Office Aurora - Jamaica Ct Office Pueblo - Hwy 50 Office
Our scheduling team will work diligently to find the right therapist for you! Keep an eye out in your email inbox. As soon as a counselor becomes available we'll send you an email with links to book online!
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