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Request an Appointment

Fill out the form below and our Intake Specialists will reach out to you shortly.

1
About You
2
Appointment
3
Insurance
About You
Client Name*
Date of Birth*
Contact Name
Email*
Phone*
OK to leave voicemail?*
Appointment Details
Type of Request*
Therapy Goal*
Insurance
Primary Insurance*
Primary Insurance ID

Not required, but speeds up verification.

Secondary Insurance
Secondary Insurance ID

Optional. Only if you have secondary coverage.

Step 1 of 3

Privacy Notice: This form is for appointment requests only. Please do not include any private health information, medical details, or sensitive personal information.

Reach Us Directly

Prefer to call or email instead?

Visit1188 Sportsplex Dr. Suite 203, Kaysville, UT 84037
HoursMonday–Friday, 9am–6pm

What happens after you submit?

One of our Intake Specialists reviews your request, checks it against your insurance, and follows up within 1–2 business days to answer questions and get you matched with the right therapist for your needs — whether that's individual, couples, family, or group therapy, in person in Kaysville or over telehealth.

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