Schedule an Appointment
To schedule an appointment, please complete the form below:
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Phone
*
Email
*
Pronouns
She/Her
He/Him
They/Them
Per/Pers
Ze/Zie
Xe/Xem
Ey/Em
Ve/Ver
Name
Insurance Provider
*
BCBS
Carelon
McLaren
BCN
BCN Advantage
Tricare
Private Pay
Aetna
Priority
Medicare
BCBS Complete
Molina
(We are only paneled with the insurances listed)
Presenting Concern
*
Depression
Anxiety
Mood Swings
Trauma
Relationships
Sexual Health & Function
Military / Law Enforcement
Testing & Assessment
Chronic Illness
Yoga / Other
Nutrition & Dietary Program
Adjustment & Transition
Sexuality
Gender-Based Issues
Other
Type of Appointment
*
Individual
Couple
Teen
Family
Group
15-Minute Conversation w/Provider
Provider
Angela Wallace-Therapist
Maha Fasihi-Therapist
Brenette Shines-Therapist
Nikhol Atkins-Yoga/Mindfulness
Stefanie McClellan-Yoga/Somatic
Shelby Banks-Nutrition
Jessica Ross-Couples Therapist
How did you hear about this?
I want to subscribe to the TCOW newsletter
Submit