Parent/Guardian Appointment Request Form at Wellness Within

Welcome to Wellness Within Collaborative. Please fill out this form if you are requesting an appointment for your child or for someone else for whom you are a guardian. We will contact you soon with next steps to find a therapist who best fits your child's needs. Thank you!

How may we contact you?*
Select any additional reasons for seeking therapy that your child is experiencing (check all that apply):
Preferred Appointment Days