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).

Start your registration by selecting the counselor you would like to schedule an appointment with in the drop down menu below. For Couples, each individual must register separately.

Counselor

Client Type

Client Information

Legal First Name / Middle Initial

Last Name

Preferred First Name ( optional )

Gender
Male Female
Prefer not to answer

Street Address

Street Address 2

City

State

ZIP Code

Cell Phone ( for Text Message Reminders )
Preferred Contact #

Home Phone
Preferred Contact #

How did you find us?
(optional) (required)

Emergency Contact

First Name

Last Name

Phone

Mobile

Relation

Street Address

City

State

ZIP Code

Log in Details

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

Confirm Email