Wellness Within Appointment Request Form

Welcome to Wellness Within Collaborative where everything we do is because you matter. Fill out this form to request an appointment for yourself. We look forward to meeting you!

How may we contact you?*
We specialize in a Collaborative Healthcare approach for Whole Person Health. What would you like to learn more about for your individual Wellness Plan?
Our Collaborative Care Coordinator, Jordan, will be reaching out to you to discuss more information about additions to your Wellness Team after you establish care with your therapist. What's the best method to contact you?
Due to COVID-19, we are still offering virtual sessions only. Are you open to teletherapy and what method is your preference? *
Preferred Appointment Days*