Appointment Request

New and Current Clients

To request a therapy appointment please fill out the forms below or you may call our office. One of the team members from Sankalpa Therapy and Wellness Center will contact you to discuss scheduling options and gather any other important information needed. Please fill out the forms completely to provide us with the most accurate information to help us place you with one of our providers.

If you would like to schedule an appointment or session with one of our Wellness Providers, please click the button below to choose your service and request an appointment.

If you have any additional questions or concerns, you can email scheduling@sankalpatwc.com

Wellness Scheduling

New Clients

New intake appointments cannot be scheduled on a Monday and must be scheduled a week in advance.

Full Legal Name

First Name

Last Name

Preferred name, if different than above

First Name

Last Name

Preferred Pronouns

What is your date of birth

YYYY

Phone Number

Preferred Method of Contact

Are you a former client?

Preferred Provider

Choose 1 provider you would like to work with:

Will you be using insurance?

If yes, who is your insurance provider?

Select from the list

Preferred Start Date

YYYY

In your own words, what brings you to seek therapy at this time?

i.e. Anxiety, depression, trauma work, ADHD, etc.

How did you hear about us?

If you selected "Other" please list

Current Clients

Appointments cannot be made day of. Must be scheduled at least 1-2 days in advance.

Name

First Name

Last Name

Phone Number

Preferred Method of Contact

Provider

Choose your provider

Requested date for next appointment

YYYY

Requested time

Hour

Minute

Second

Additional Information

Appointments and Cancellations

Please remember to cancel or reschedule 48 hours in advance. You will be responsible for the entire fee if cancellation is less than 48 hours.

The standard meeting time for psychotherapy is 50 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 50-minute session need to be discussed with the therapist in order for time to be scheduled in advance.

Cancellations and re-scheduled sessions will be subject to a full charge if not received at least 48 hours in advance. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.