480-482-1838

By completing the form below, our scheduling team-Claudia Perez and Erika Perez-will be in contact with you right away to get you scheduled with a counselor. In addition, you will be providing the necessary information to complete your new client chart- No need to provide this information again.

Name of individual completing this form*

Email*

Phone*

Client Date of Birth*

Client Home Address*

Insurance (Aetna, Banner Aetna, BCBS, Cigna, UHC/Optum)

Preferred Meeting Location (Mesa, Scottsdale, Phoenix, Tucson, Virtual/Telehealth)*

Is there a certain day or time of day that works best for your schedule?*

Do you prefer a female, male or no preference?*

Attach Insurance Card

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Hours

Open today

10:00 am – 08:00 pm

Meet our Scheduling Team

Claudia Perez

Erika Perez

Claudia Perez

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