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BMHKY
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FAQ
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Request an Appointment
Full Name
*
Email
*
I am requesting an appointment for
*
myself
someone else
If requesting an appointment for someone else, please provide their full name.
Driver's License or other form of ID for individual that will be receiving services
*
Upload File
Front and Back of Insurance Card for individual that will be receiving services
*
Upload File
Preferred Therapist
*
No Preference
Galen McIntosh, LCSW
Jennifer Dixon, LCSW
Phyllis Leigh, LCSW
Stephanie Ruanto, LCSW
Ashley Malone, CSW
Lynn Thompson, LCSW
Christian Briney, CSW
My preferred time to meet is
*
whenever. I am flexible.
before 12:00pm.
after 12:00pm.
after traditional business hours.
weekends.
The majority of our clinicians are providing services via telehealth ONLY. Are you okay with telehealth services?
*
yes
no
Provide a brief description of what brings you here. Please include current stressors, symptomology, preferred treatment modality (if applicable), etc.
*
Submit
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