Waitlist & Non Client Contact

Are you a new client and would like to schedule a session? Please fill out the waitlist form below.

Are you a medical professional, business contact, or other interested party?

The Help Couch Client Waitlist

We strive to provide industry leading mental health services to our community. Sometimes, during periods of high client need, our session times fill up. If you'd like to be added to the waitlist please fill out the following form. *

*Filling out the form is not a guarantee of service.

First Name

Last Name

Phone

Is it OK to text you about scheduling?

Yes

Type of sessions you are interested in.

Individual

Couples

Both

Would you like in-person or a virtual session.

In-Person

Virtual/Remote

Doesn't matter

Preferred Therapist

Select your payment method.

Cash/Out Of Pocket

Blue Cross Blue Shield

Blue Care Network

HAP

United Health Care/Optum

Additional information you would like us to know (availability restrictions, etc).

Thank you your information was received.

Non Waitlist Contact Form

Non Client Contact Form
(Medical Professionals, Business Contact, Vendors, and Other Non Clients)

First Name

Last Name

Phone

Let us know why you are reaching out

Thanks, someone will be in touch.

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Waitlist & Non Client Contact

Non Client Contact Form (Medical Professionals, Business Contact, Vendors, and Other Non Clients)

Non Client Contact Form
(Medical Professionals, Business Contact, Vendors, and Other Non Clients)