Request an Appointment — L & C Therapy

Let’s Connect.

We typically respond within 24 hours or the next business day.

If this is a mental heath emergency please call or text 988.

Request an Appointment

Guardian Information

First Name

Last Name

Email

Phone

(###)

###

####

Client Name

Client Age

School Client Attends

Referred by Anyone?

Please provide a brief summary of the situation.

Past or current suicidal ideations?

if current, call or text 988

Any past or current involvement with Department of Child Services? (DCS)

Current or past divorce or custody proceedings?

Therapist Requested? (Dependent on availability)