MHaWC

Mental Health and Wellness Clinic

Fields with asterisks (*) are required.

Preferred contact information

Preferred contact information *
May we leave a message (if phone number)? *
May we leave a text message (if phone number)? *
What is your preferred session time frames? (Please check all that apply) *
Do you have a computer? *
Do you have internet access? *
What is your preferred method of therapy? *
To participate in Telehealth services, it is necessary that you have reliable telephone/cell service and/or access to a reliable internet connection, and be able to meet in a private and quiet location. Please confirm that you have these capabilities.