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BMHKY
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Request an Appointment

Please Note: This form is for scheduling purposes only and is not monitored 24/7. If you are experiencing a mental health emergency or need immediate assistance, please call 988, go to the nearest emergency room,

or contact the Crisis Text Line by texting HOME to 741741.

Full Name*

Email Address*

What brings you to therapy?*

The majority of our clinicians are providing services via telehealth ONLY. Are you okay with telehealth services?*

Yes

No

Preferred Therapist*

No Preference

Jennifer Dixon, LCSW-S (limited in person availability)

Galen McIntosh, LCSW

Phyllis Leigh, LCSW-S (Tuesday availability only)

Stephanie Ruanto, LCSW

Lynn Thompson, LCSW-S

Ashley Malone, CSW

Christian Briney, CSW

Lynette Anderson, LCADC, CSW

Taylor Stratman, CSW

My preferred time to meet is*

Whenever. I am flexible.

Before 12:00pm.

After 12:00pm.

Non-traditional business hours.

Weekends.

Driver's License/Identification Card*

Will you be using insurance? *

Yes

No

Front/Back of Insurance Card

How did you hear about us?*

2021 by BMHKY

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