Intake Form

Fill out this form to initiate services and contact our intake coordinator.

Please give us as much non-confidential information as possible about your situation and what services or therapy you desire. Our intake coordinator will contact you within 2 working days with more information. Please keep in mind that email is not secure, nor HIPAA compliant.

If you would like to set up an in-person meeting with our intake coordinator and have a tour of our center, please let us know below. In-office meetings and tours can be arranged for most weekday mornings.

Call to schedule a visit at (216) 514-1600 or contact us.