Who is this appointment for? *

You can request this appointment for yourself, on behalf of someone else, or for both you and your partner. Please choose below.

Me

My Partner and Me

Someone Else

Contact Name *

First Name

Last Name

Client Information *

This will only be shared within the practice.

First Name

Last Name

Client Phone *

(###)

###

####

Therapist Preference

Select the therapist(s) of interest.

Tallia Doyle, LCSW - 1-2 week waitlist, in-person & virtual sessions

Christine Turner, LCSW - not accepting new clients

Sarah VanderVliet, LAC - virtual sessions, out-of-pocket only

Karl Kleppe, LAC - in-person & virtual sessions, out-of-pocket only

Kylee Rucker, Therapy Intern - in-person & virtual sessions, out-of-pocket only

Payment Preference *

Select preferred payment option(s).

Out-of-Pocket (HSA/FSA, Cash, Card, Zelle, etc)

In-Network Insurance (Aetna or United for Tallia Only)

Out-of-Network Insurance with Superbill

Appointment Location *

In-person

Virtual Video

Via Phone

Appointment Availability - Days

Please select the day(s) you are available for an appointment from the options below:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Appointment Availability - Times (30 mins) *

Please select the time(s) you are available for an appointment from the options below:

Morning

Noon

Afternoon

Evening