Appointment Request

To schedule a telephone intake conversation with the intake coordinator for individual or couples therapy, or to obtain additional information about any of our therapy services, please fill out the form below or call 413-587-0095 Ext. 4.  Intake calls are returned Mondays and Tuesdays before 3, Thursday afternoons, and during weekend times.

Please bring this Intake Form completely signed and initialed to your first appointment.



We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website.This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Helpful Forms

Click here to view and print forms for your appointment.