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Request Appointment

This online form is a convenient way to schedule appointments; however, please contact us by phone if you need any assistance. If you do not complete the required paperwork by the day before your intake appointment the appointment will be cancelled and would need to be rescheduled after the paperwork is completed. Appointments cannot be completed without the proper consents and insurance verification if applicable. All no-show appointments will be charged a $50.00 missed appointment fee. All appointments are virtual.
Client Status:
Service:
Therapy Intake
Location:
Any Available Location
Dr. Denine Hasan, Ed.D, Licensed Professional Counselor
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