Help for times when your life has changed… or needs to change.

The first step in your healing journey is to fill out this form.

‍Next, we’ll get you connected with one of our therapists, who will help you sort through the clutter and confusion so that you can become the best version of yourself right now.

First Name

Last Name

Email Address

Mobile Number

What is your preferred method of contact? *

Preferred Time For Appointments*

What is your preference regarding email and voicemail communication from Pivot Counseling?*

What is your preferred way to meet for therapy sessions? *

Insurance Provider*

Brief Description of Concerns

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Pivot Counseling PLLC harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Help for times when your life has changed… or needs to change.

Search Pivot

Quick Links:

Start moving forward.