REQUEST AN APPOINTMENT

Our Care Coordinator is ready to help you get started.

This form is a convenient way to contact us about scheduling a first visit appointment. You can also contact our Care Coordinator at 833-914-4688 or info@thrivepointe.com.

Rate and Payment Information

We do not accept insurance. Our clients self-pay (cash, check, or credit card) or use an HSA to pay for counseling sessions at the time of service.

Rates vary, but the most typical session fee is $140, and the first visit fee is $175. You can view each therapist’s rate online. We’re happy to answer your questions about payment and insurance.

Your Name: *

First

Last

Phone: *

Email: *

Home Address: *

Client's Name (If Different):

First

Last

Name of Parent/Guardian 1 (minor clients only)

First

Last

Name of Parent/Guardian 2 (minor clients only)

First

Last

Phone of Parent/Guardian 1 (minor clients only)

Phone of Parent/Guardian 2 (minor clients only)

Email of Parent/Guardian 1 (minor clients only)

Email of Parent/Guardian 2 (minor clients only)

Indicate any Custody Documentation and List Parents/Guardians with Parenting Rights (minor clients only)

Type of Counseling Requested: *

Client Date of Birth: *

Preferred Method of Contact: *

Phone
Email
No preference

How can we help you? Please include a few sentences about why you are seeking therapy. *

We typically schedule appointments weekly, but it may be more or less frequent, depending on your needs. What days/time frame are you available for appointments? *

How did you hear about us? *

New Clients

Our Care Coordinator will reach out after reviewing your appointment request. The information you provide below helps us to match you with a therapist who will be a great fit for your needs.

Existing Clients

Please contract your therapist to schedule an appointment. Phone and email contact information is listed on the therapist bio pages.