Name

First Name

Last Name

Phone *

(###)

###

####

Do you have a therapist you prefer or have been referred to? *

Beth Houle (Not currently accepting new clients)

Jennifer Weller

Alicia Boggess

Lara Kate Todd

Crystal Fawley

Maddie Storz

Courtney Liljekvist

Bailey Spradling

Ali Goodman

None/First available

Preferred Location

Cleveland, TN

Chattanooga, TN

Telehealth

No preference

What services are you seeking? *

Check all that apply

Individual Therapy

Couples Therapy

Family Therapy

Play therapy