Contact Us We’re here to support you every step of the way. For new clients ready to take the next step, fill out the form below to get started. Let us help you unlock you or your child’s full potential today! New Client Inquiry Form Client Name * First Name Last Name Preferred Pronouns Client's Date of Birth * MM DD YYYY Caregiver Name (if applicable) First Name Last Name Client or Caregiver Email * Client or Caregiver Phone (###) ### #### Which clinician would you like to meet with? Dr. Christine Hook (psychological testing only, ages 3-22) Shelley Chambers (therapy & co-parenting, all ages) Maddie Haddock (therapy, ages 7+) Buffy Taylor (therapy, ages 25+) Insurance Coverage * (Therapy Services Only) *Please note the in-network providers next to the insurance company name. If your insurance is not listed, we are out of network. BCBS (Shelley Chambers, Maddie Haddock, and Buffy Taylor) Aetna (Shelley Chambers, Buffy Taylor, and Maddie Haddock) Cigna (Buffy Taylor only) United Healthcare (Buffy Taylor only) Medicare Part B (Buffy Taylor only) Tricare (Maddie Haddock only) Therapy Only: Are you seeking in-person or virtual appointments? *Virtual appointments are unavailable for Shelley Chambers, LCSW* In-Person Virtual Presenting Concerns * Custody Acknowledgement (for treatment of minors) Is there any active or past court involvement regarding custody arrangements? Please note that we require all legal guardians to consent to treatment in the event of separation or divorce. Yes No For treatment of minors: If you are separated or divorced, please share the other parent's name and email address below: How did you hear about us? Google Search Referral from Friend/Family Referral from Healthcare Provider Referral from School Counselor or Teacher Referral from Another Professional Returning Client If you were referred to us, let us know who sent you! Thank you! We will get back to you within two business days. Please check your spam folder for our response!
