Total Life Onboarding

1

Feeling comfortable and confident from the beginning is important. We're here to help you along your journey towards better mental health. If at anytime you would like to speak with a team member please call 1-800-567-5433. If this is an emergency please dial 911.
2
Select your State of Residence* This field is required.Thank you for joining us on this journey. In order to verify that we have a therapist available in your state, could you please let us know which state you live in?
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
3
What's your Name?* This field is required.I am happy to inform you that we do serve your state. To continue the process, may I have your name?
First Name
Last Name
4
Email Address* This field is required.It's nice to meet you. Could you please provide the best email address for us to reach you at? We will use this email to contact you with important care information.
5
Phone Number* This field is required.Could you please provide your mobile phone number for us to reach you at? If you do not have a mobile phone number, please enter your landline. We will use this number to contact you with important care information.
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Your Privacy is Important to Us* This field is required.Here are our terms and conditions Total Life is committed to protecting your privacy.
I agree to the terms and conditions
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