New Clients - True North Therapy

Scott is available for new adult clients.

Jayne is currently accepting new adult clients.

Brian has limited availability for private pay clients.

We are unable to accommodate marital/couples counseling requests.

Name of Person Completing Form *

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Prospective Client's Legal Name *

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Prospective Client's Date of Birth *

Email Address for Contact *

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Phone Number for Contact *

How May We Contact You? *

Prospective New Client for *

Health Insurance Company (or Private-Pay) *

Prospective Client's Scheduling Availability *

Briefly Describe Your Current Concerns *

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