Request an Appointment Complete the information requested below and submit. We will contact you to set up an appointment. First Name(required) Last Name(required) If a Minor-Parents Name Phone(required) Email (required) Date of Birth(required) Address(required) Apt/Suite City(required) Zip/Postal Code(required) Insurance Company and ID numbers(required) Reason you are seeking counseling(required) Individual or Couples?(required) Are you looking for telehealth or in person sessions?(required) Do you have a preference for a male or female counselor?(required) What is your availability? (We are open Monday-Thursday 10am-6pm)(required) How did you hear about GlassWing Counseling?(required) Anything else you would like us to know? Submit Δ
