Appointment Request

To schedule an individual, children, couples, marriage or family therapy appointment or to obtain additional information about any of these counseling services, please fill out the form below or for a more timely response please call us at 848-404-9111.

If you are using the form below to request an appointment, please note in the box below if your are requesting a particular counselor and if you want individual or couples counseling.   Thank you.

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.