Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Please complete all required digitally filled registration forms, as are located within our portal for each Client's individualized access: Registration Form; Policy & Procedure Form; Information & Consent Form; Duty To Warn Form; Fee Agreement Form; No Show and Cancellation Policy Form; Biographical Information Form (Adult); and/or (applicable only) Biographical Information Form (Child).

Thank you!

Client Information

/ Middle Initial

( optional )
 
( Must be at least 18 years old )
( MM-DD-YYYY )







( for Text Message Reminders )


Bill To Contact

Emergency Contact


First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )