Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Therapist

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )








( for Text Message Reminders )

Bill To Contact


/ Middle Initial







Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Informed Consent

Please review forms section and review intake packet, cancellation policy and privacy practices.  Your signature in this section acknowledges that you received and reviewed these forms.

( Type Full Name )