General Contact Form

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Your Info
2
Your Needs
3
About You
4
Confirm

A Quick Note About Privacy

This form is not secure. Please do not share private or personal health information here. Do not include a child's name, date of birth, diagnoses, test results, school records, medical history, or insurance information. If you need to share private information or ask clinical questions, please contact our office directly or use our secure patient portal.

Emergency Notice

If you or your child are experiencing a medical or mental health emergency, please call 911 or go to your nearest emergency room. Our office does not provide emergency or crisis services.

1
Contact Info
2
Your Needs
3
About You
4
Review & Submit

Your Contact Information

Let us know how to reach you.

Contact Preferences

Preferred Method of Contact (optional)
Preferred Time to be Contacted (optional)

Tell Us About Your Needs

Help us understand how we can best assist you.

Why Are You Contacting Us? (required)
Services of Interest (required)
Preferred Appointment Availability (optional)

General Background (Non-Clinical) (optional)

Please answer the following questions in very general terms. Do not include identifying, medical, or school-specific information.

Your Message (required)

Please keep your message general. Do not include personal, medical, or school details about your child or family.

Tell Us About Yourself

This helps us better understand your situation.

You Are A (optional)
Child's Age Range (optional)
How Did You Hear About Us? (optional)

Almost There!

Please review and accept the following to submit your form.

Consent & Acknowledgments (required)

What Happens Next

We typically respond to general inquiries within 2–3 business days. If your message is time-sensitive, please contact our office directly.

Thank You for Reaching Out!

Your message has been received.

A confirmation email has been sent to your inbox. Please check your email (including spam/junk folders) for a copy of your submission and next steps.

What Happens Next

  • We'll review your message within 2–3 business days
  • A team member will reach out using your preferred contact method

Emergency Notice

If you or your child are experiencing a medical or mental health emergency, please call 911 or go to your nearest emergency room. Our office does not provide emergency or crisis services.