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NEW CLIENT INTAKE

Referral & Intake Form

You’ve already taken the first and hardest step. Complete the form below and we’ll be in touch within 1–2 business days.

We’re so glad
you’re
here.

It can be scary to get started, but we are confident you are ready to change your life. Share as much or as little as you’re comfortable with — there are no wrong answers.

Response within 1–2 business days

A clinician will reach out to discuss next steps.

🔐 Everything is confidential

Protected under HIPAA. Never shared without your consent.

💻 100% telehealth — no commute

 Sessions from wherever you feel most comfortable.

🮜 Culturally affirming care

You will be seen, honored, and met exactly where you are.

⚠ Not for emergencies. If you are in crisis call 911 or call/text 988 (24/7).
SC Mobile Crisis: 833-364-2274

Tell Us About You

All fields marked * are required. Your information is strictly confidential.


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