Schedule an AppointmentTrue to Herself Therapy for Girls and Women

top of page

Home
Therapists
- Lakita Allen
- Zoie Alexander Walker
Schedule an Appointment
New Client Information
Professional Referral Form
Contact, Location & Hours
More

Use tab to navigate through the menu items.

Appointment Request Form

It all starts with you! Contact us today!

Parent's First and Last Name

Child's First and Last Name

Child's Date of Birth (format: month/day/year)

Parent's Email

Parent's Phone Number *(format: no dashes)*

Primary Insurance

Secondary Insurance (if applicable)

Location

Depending on the age of the client and presenting challenges, therapist may recommend in person after assessment.

Do you currently have any ongoing child custody/vistation cases or legal proceedings related to the care of your children

Do you currently have any open cases with the Department of Social Services (DSS)? or Have you ever been involved in a DSS case that is still ongoing?

Therapist Preference

Each Therapist has different wait times.

Best Day(s) for Therapy (check all that apply) *

Monday

Tuesday

Wednesday

Thursday

Friday

Best Time(s) for Therapy ( check all that apply) *

10 AM- 11 AM

11 AM- 12 PM

12 PM - 1 PM

1 PM- 2 PM

2 PM- 3 PM

3 PM - 4 PM

4 PM- 5 PM

Please be aware that most afterschool times more than likely will have a wait time, please ensure that all times and days are selected that client is able to come for therapy. Medical excuses are given for any appointments scheduled during school hours. We will inform parent with the waitlist time, if applicable once we receive this form.

Reason(s) for seeking therapy for your child/teen?

I accept being contacted via call, text or email in reference to this submission *

Thank you for submitting! We will be in contact soon!

Address

330 Pelham Road, Ste. 210B

Greenville, SC 29615

Phone and Fax

Phone: (864) 332-9956

Fax: (864) 686-5516

Email

info@truetoherselftherapy.com

Connect

Office Hours

Monday - Friday

10 AM - 5 PM

bottom of page