Contact Us

Client Name *

First Name

Last Name

Caregiver Name (if applicable)

First Name

Last Name

Client or Caregiver Phone

(###)

###

####

Client's Date of Birth *

MM

DD

YYYY

Which clinician would you like to meet with?

Dr. Christine Hook (psychological testing only, ages 3-22)

Shelley Chambers (therapy & co-parenting, all ages)

Maddie Haddock (therapy, ages 7+)

Buffy Taylor (therapy, ages 25+)

Insurance Coverage - *Therapy Services Only

Please note the in-network providers next to the insurance company name. If your insurance is not listed, we are out of network.

BCBS (Shelley Chambers, Maddie Haddock, and Buffy Taylor)

Aetna (Buffy Taylor only)

Cigna (Buffy Taylor only)

United Healthcare (Buffy Taylor only)

Tricare (Maddie Haddock only)

Custody Acknowledgement (for treatment of minors)

Is there any active or past court involvement regarding custody arrangements? If yes, please note that we require all legal guardians to consent for treatment.

Yes

No