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Opening Door to Home Office
Therapy Appointment Request Form

It all starts with you! Contact us today! 

This form is intended for female Adults only!

Clients have to be located in either South Carolina to see Ms. Lakita Allen and South Carolina or Connecticut to see Mrs. Zoie Alexander Walker virtually. 
For clients requesting virtual only, depending on presenting challenges, therapist may recommend in person after assessment. 
Note: Each Therapist wait times vary. 
Best Day(s) for Therapy (check all that apply) Required
Best Time(s) for Therapy ( check all that apply) Required
Please be aware that most afternoon times more than likely will have a wait time, please ensure that all times and days are selected that you're able to come for therapy. Medical excuses are given for any appointments scheduled during the day, if needed. We will inform you of the estimated waitlist time during the initial assessment. 
Presenting Challenges/Reason for seeking therapy (What concerns are you hoping to address with your therapist? (check all that apply) Required
Are you currently experiencing any of the following? (Check any that apply. This information helps us understand how to support you best Required
This form is not monitored 24/7. If you are in immediate danger or experiencing a crisis, please contact 911 or the National Suicide & Crisis Lifeline at 988.
I give consent to being contacted via call, text or email in reference to this therapy appointment request. I understand that this form is not for emergencies, and I should go directly to the nearest emergency room or call 911 for emergencies. Required

Thank you for submitting! We will be in contact soon via text, call or email.

Address

330 Pelham Road, Ste. 210B

Greenville, SC 29615

Phone and Fax

Phone: (864) 332-9956

Fax:  (864) 686-5516

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Email

info@truetoherselftherapy.com

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Office Hours

Monday - Friday

11 AM - 5 PM

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