Contact | Jessica & Michael

“The only impossible journey is the one you never begin.” – Tony Robbins

Let's Chat
We will respond to you within 48-72 business hours. Please note our business hours are Monday through Thursday 8am-4pm for any clerical work (emails, forms, phone calls). You may follow up by text at 813.657.2100 if you have any questions. For faster response times, please make sure you complete all fields and upload your insurance card and DL

First Name (Potential Client)

Last Name

Parent Name or Partner First Name

Last Name

Minor email or Partner email

Person filling this out Email

Phone

Birthdate of client required

Name of Insurance (write self pay if no insurane)

Insurance Benefits Number

Front of Insurance Card

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Type of Counseling Required

Family

Individual

Couples

Child

Back of Insurance Card

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Driver's License or ID

Upload File

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Therapist Choices Required

Jessica

Michael

Matita

Katie

We will do our best to place you with the therapist of your choice. Based on your reasoning for coming, we may place you with someone different that has more experience or may be a better fit.

You only need to submit this form once. You may reach out to us by text or phone at 813.657.2100

Please tell us the reason for being seen to match you appropriately. Vague detail will delay services

Thank you for submitting. We try to respond to all messages within 48-72 business hours. You may also text us at 813.657.2100