Request a Self-Pay Appointment

We’re glad you’re here! Please fill out the form below to request a self-pay appointment. Our office will contact you within 1-2 business days to review your information and scheduling options.

Please note:

  • This form is for patients who are not using insurance for their visit. If you would like to use insurance, please schedule directly through our Headway portal.

  • Completing this form does not establish a patient–provider relationship until your appointment is confirmed.

  • This form is for non-urgent appointment requests only. If you are experiencing a mental health emergency, call 911 or go to your nearest emergency department. You can also dial 988 to connect with the Suicide & Crisis Lifeline.