Phone Consultation Form

In preparation for our potential time together, we've found that a phone consultation is key to getting our new families started off right. In this time together, we hope to find out what service will work best for you and your child and, in turn, how we can make the most of our time together.
NOTE: If you are interested in working with Colleen Nolan at the S. Charlotte location, that is now “Heartcentered.” Please click here to contact Colleen.

Please complete the form below and we will be in touch with you via email to schedule a time for the phone consultation.

Your Name (Parent) *
Your Name (Parent)
Your Child's Name *
Your Child's Name
Phone *
Would you be interested in working with a provider to help lift your burden, give you hope, and help your child progress? *
Would you be interested in working with a more holistic provider who treats more than just a diagnosis? *

Privacy Policy

The HIPAA privacy rule requires covered entities to safeguard certain Protected Health Information (PHI) related to a person’s healthcare. Information being sent to you may include PHI, after appropriate consent, acknowledgement, or authorization. You, the recipient, are obligated to maintain PHI in a safe and secure manner. You may not re-disclose this patient information without additional patient consent. Unauthorized re-disclosure or failure to safeguard PHI could subject us, or you, to penalties described in federal (HIPAA) and state law. You can read more about your rights by clicking here.

All information transmitted through this site will be held in confidence. Email addresses will not be shared in any way.