Become a Client/Contact Us

The best way to contact us is to fill out the form below. You can also call the general phone at 614.352.2946.

NEW CLIENT/Inquiry Form/Request Records

Name of prospective client or person seeking info

First

Last

Email

Phone

Payment/insurance info

Message- Tell us what you need.

Day/Time Proposed city

Columbus Ohio Office IN-PERSON Day/Time session availability

Check all the days and times you can attend sessions.

New Albany Ohio Office IN-PERSON

Check all the days and times you can attend sessions.

Homeworth/Alliance OH IN-PERSON (2.5 hours from Columbus)

Check all the days and times you can attend sessions.

List other times days/times you could schedule.

Age of Proposed Client (we currently only see age 14+)

List city and state proposed client lives in

Name of person filling out form if different from above

First

Last

Relationship of person filling out form to prospective client if different