Let’s work together.

Interested in working together? Fill out some info and we will be in touch shortly! If you are experiencing a mental health emergency, please contact your local ER.

Name

First Name

Last Name

Do you have insurance?

Yes

I am not sure.

What brings you to therapy?

Please describe briefly topics and concerns that may arise in our therapy sessions. You will have the opportunity to complete more detailed forms at a later date!

Phone

This is not required. You agree to receive informational messages (appointment reminders, account notifications, etc.) from Desired Path Therapy. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at hello@desiredpaththerapy.com. You can opt out at any time by replying STOP.

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How can we contact you?

I prefer a phone-call.

I prefer an e-mail!

I prefer a text.

I do not care.

Consent to receive SMS messages.

Messaging Terms & ConditionsYou agree to receive informational messages (appointment reminders, account notifications, etc.) from Desired Path Therapy. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at hello@desiredpaththerapy.com. You can opt out at any time by replying STOP. Mobile SMS Messaging Privacy Policy: Information collected: We may collect information, such as name, phone number, and email address.Use of information collected: We may use the information we collect to perform the services requested including billing, customer service, appointment reminders and other administrative requests. Sharing of information collected: We may share information we collect with payment processors, legal authorities, partners so that these service providers can perform their normal duties. We do not share, sell, rent, or trade any information provided with third parties for promotional purposes. As a current or prospective client, you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help regarding your account or scheduling needs. This is not a crisis support line and will not assist those experiencing mental health emergencies. You understand that the messaging frequency may vary. Messaging & data rates may apply. Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail

Yes, I consent to receive text messages regarding scheduling.

No, I do not want a text message. Phone call/Email only.