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Online Therapy
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Getting Started
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About Us
About Us
Mission and Values
FAQs
Online Therapy
Services
Online Therapy
Assessment
Continuing Education
Groups & Camps
Therapy
Our Team
Media
Getting Started
Contact
Getting Started
Online Intake Form
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Your Contact Number
*
Your Email Address
*
Zip Code
*
Primary Concern
Referral Source (if applicable)
Client's Name (if not individual listed above)
First
Last
Client's Date of Birth (if not individual listed above)
Date Format: MM slash DD slash YYYY
Your Relationship to Client
Custody Status (if applicable)
School Attending (if applicable)
Do you have a preferred clinician, or were you referred to a specific clinician (please specify)?
- Select a Clinician -
Dave Verhaagen, PHD, ABPP
Lauren King, PSYD
James Goodlad, PHD
Caitlin Rissler, NP
Danielle Mizell, PSYD
Brittany Rader, PHD
Laura Hamilton, M.Ed., NCC
Eli Parrot, PHD, LMFT
Bonny Kate Simpkins, MMFC/T
A.J. Heritage, PHD
Cameron Gordon, PHD
Blake Tims, LMFT-T, MMFC
Southeast Psych puts psychology into the hands of as many people as possible to enhance their lives.
FAQs for New Clients
Getting Started by Phone 615-373-9955
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