Client Queue & Non Client Contact

Are you a new client interested in scheduling a session? Please fill out the form below.

The Help Couch Client Queue

We strive to provide industry leading mental health services to our community. Sometimes, during periods of high client need we queue clients to ensure orderly and timely service. If you'd like to be contacted for scheduling 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

Would you like in-person or a virtual session. *

In-Person

Virtual/Remote

Doesn't matter

Preferred Therapist

Select your payment method. Please note we are not currently accepting Medicaid *

Cash/Out Of Pocket

Blue Cross Blue Shield

Blue Care Network

HAP

United Health Care/Optum

Priority

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
Are you a medical professional, business contact, or other interested party?
Please fill out the form below and someone will be in touch.
(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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Client Queue & Non Client Contact

Non Client Contact Form Are you a medical professional, business contact, or other interested party? Please fill out the form below and someone will be in touch. (Medical Professionals, Business Contact, Vendors, and Other Non Clients)

Non Client Contact Form
Are you a medical professional, business contact, or other interested party?
Please fill out the form below and someone will be in touch.
(Medical Professionals, Business Contact, Vendors, and Other Non Clients)