New Client Appt. Request — Clear Water Wellness LLC

Request An Initial Appointment

Are you a new client and looking to receive therapy services? You’ve in the right spot! We aim to make first-appointment setup easy and painless. Take a look at our helpful breakdown of What To Expect if you have any questions about working with us at Clear Water Wellness. (Looking to inquire more but not sure if you want to request an appt. yet? Ask a question here.)

Fill out the form below and we’ll get in touch with you soon about getting you scheduled!

Name

First Name

Last Name

Phone

(###)

###

####

I am seeking therapy for my child

Child's Name

First Name

Last Name

Child's Age

Can you briefly explain why you are seeking counseling?

What is your availability?

Please list the days of the week and times that work best with your schedule. Appointments are typically an hour.

Have you ever received counseling before?

How did you hear about us?

Anything else you would like us to know?

I understand Clear Water Wellness is an out-of-network provider & it is my responsibility to provide payment at time of service. Click here to learn more.

I Understand