Welcome To Affirmations!

"Guiding Your Journeys of Discovery with Insight & Heart"

918 South Front Street, Columbus, Ohio 43206
(800) 285-9397, Fax/TTY: (614) 445-8283
Call us at: (614) 445-8277

SETTING UP YOUR FIRST APPOINTMENT

Setting up your first appointment is easy to do.

We want to affirm your courage for reaching out and we will respond as quickly as possible to your request.

Please fill in the form below and email it to us and one of our staff will get back to you with information about your first appointment, usually within 24 hours during the week, and within 48 hours if you contact us during the weekend.

Please be assured that any and all information you submit on this form will be kept in strict confidence, as we treat all client information at Affirmations. Your name and information supplied will not be sold, nor given to anyone else outside of the staff of Affirmations.

Name:
Address:
City:
State:
Zip Code:
Country:
Phone:
Work Phone:
Fax:
Email:

Please call me to schedule my first appointment.

You may call me at:
Best hours to reach me are:

Requested Therapist (if available):
Insurance Coverage (if Private Pay please indicate this):

I am interested in (check all that apply:)

	Individual Psychotherapy
	Group Psychotherapy
	Couples or Family Psychotherapy