If your insurance company will not cover therapy please use our forms below to enter your personal information, submit a payment, and request an appointment. We will be in touch shortly to confirm your appointment date and time.
Step 1. Enter your information by filling out the Private Pay form below. Once you hit submit you will be brought to a secure page where you can enter your credit card information. Upon completion come back here and proceed to step 2.
Step 2. Use our online booking system to request an appointment
Once everything is verified you will be scheduled and notified.
PRIVATE PAY INFORMATION