Quick Lead Form Template

Wondering if therapy is right for you?

TAKE THE
FIRST STEP!

Therapy helps people of all ages work through issues, learn how to live with learning disabilities, and build better relationships.

If you are struggling with any of these, give us a call or send us a message. We'll be happy to talk about your options.

First, we'll need
some information:

* Indicates required questions

Submissions made through this form may be monitored in compliance with HIPAA regulations.

Name *

First

Last

Email *

Phone # *

Which location do you prefer?

Brighton Plymouth

How can we help you? *

How did you hear about us? *

Join Our Newsletter

Brighton Office

Phone Number
(810) 224-1676

Plymouth Office

Phone Number
(734) 416-9098

Helpful Links