911 or go to the nearest emergency room
988 for 24/7 crisis support through calling or texting
1-800-231-1127 Common Ground 24/7 Crisis Line
248-983-5454 Common Ground Behavioral Health Urgent Care for same-day appointments

WE WOULD LOVE TO HEAR FROM YOU!

Getting in touch with us is easy. To schedule an appointment or inquire about our services, you can reach out to us through our website, email, or phone. Our friendly team is ready to assist you and answer any questions you may have. We understand that reaching out for support takes courage, and we deeply appreciate your trust in our practice. Your well-being is our priority, and we are here to provide the compassionate and professional care you deserve. Don't hesitate to contact us – we look forward to connecting with you and supporting you on your journey to healing and growth.

IF YOU ARE IN CRISIS, PLEASE REFER TO THE CRISIS SUPPORT RESOURCE INFORMATION AT THE TOP OF THIS PAGE

Name

First Name

Last Name

Phone

(###)

###

####

I am interested in

I would like to see

How did you hear about us?

What type of insurance do you have?

Best way to reach you

Best time to reach you

Hour

Minute

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Session Preference

Scheduling Needs

Please let us know your availability to attend sessions. If you are flexible, need morning, afternoon, or evening sessions, or can only attend certain times, please be as specific as possible. This will help us better match you with a therapist.

What brings you to look for therapy at this time?

What do you hope to get out of therapy?

Have you been to therapy before?

Yes

Have you had any psychiatric hospitalizations?

Yes

If so, then why?

Have you been in treatment for any substance use disorders or eating disorders?

Yes

Are you a resident of Michigan?

Yes

Communication Consent

By submitting this form, you consent to receive communication from us regarding what you submitted, and it is assumed you are interested in services.

I consent to be contacted via phone such as phone calls, voicemails, or text messages and I consent to being contacted via email.