Our main portal system is currently down for upgrades. We will notify you via email when it returns. In the meantime, please use this form for appointment requests or scheduling changes.

Your Details

Answer 'yes' if you have previously completed our intake form, even if you have not yet met with a provider.

We require that new clients complete our intake process before any scheduling can take place. Please click the button below to start the intake process.


Please give the email that is currently on our system for you.

Pick a time and day



I'd like to cancel my upcoming appointment on the date below. I understand that if the time of submission of this form (by pressing the submit button) is within 24 hours of my appointment time then I will be responsible for a late-cancel fee.

in exchange for the following appointment

Your provider may not be available for the times you select, but we will endeavor to get as close as possible to your request.


Pressing the button below will submit this form to our admin staff. Requests are processed on a first-come, first-served basis, based on the date and time of submission. You will receive an email or a call with confirmation of your request once it has been processed. Please allow for up to 2 business days for a response. If you have any difficulty using this form and instead would like to speak to our admin team, please call (360) 329-2055. Thank you.