Skip to content
Search for:
Home
Services & Programs
Academic Success Services
Addictions Program
Adolescent Program
Anxiety Disorders Program
Post-IOP Program
Child Services
Corporate Services
Employee Assistance Program
Executive Coaching
Health & Disease Management
Integrated Healthcare Program
Interpersonal Trauma
Special Programs
Telephonic Counseling
Testing and Evaluation
Individual and Couples Therapy
Group Therapy
OCD Group
Family Services Group
Teen Girls’ Group
New Mothers’ Group
Men’s Group
Eating Disorders Group
Parenting Skills Program
Social Skills Groups for Girls and Boys
Strategies for Academic Success
Relationship Skills Group
Assertiveness Skills Group
Mindfulness
Willpower Workout Group
Woman’s Issues Group
Singles Seeking Relationships
Children of Divorce Group
Work & Family Life Workshop
Health & Wellness
About Us
Our Leadership
Dr. Vanessa Gourdine, Psy.D, APN-C, CFMP
Dr. Cynthia Orosy, Ph.D.
Locations/Contact Us
Application
Menu of Services
Triparte Organization
Testimonials
Admissions
Free Workshops
Professional Referrals
Insurance & Payment
Make An Appointment
Resources
Ask A Therapist: Question and Answers Survey
Client Satisfaction Survey
Links
Free Services
Blog
Forms
Home
Services & Programs
Academic Success Services
Addictions Program
Adolescent Program
Anxiety Disorders Program
Post-IOP Program
Child Services
Corporate Services
Employee Assistance Program
Executive Coaching
Health & Disease Management
Integrated Healthcare Program
Interpersonal Trauma
Special Programs
Telephonic Counseling
Testing and Evaluation
Individual and Couples Therapy
Group Therapy
OCD Group
Family Services Group
Teen Girls’ Group
New Mothers’ Group
Men’s Group
Eating Disorders Group
Parenting Skills Program
Social Skills Groups for Girls and Boys
Strategies for Academic Success
Relationship Skills Group
Assertiveness Skills Group
Mindfulness
Willpower Workout Group
Woman’s Issues Group
Singles Seeking Relationships
Children of Divorce Group
Work & Family Life Workshop
Health & Wellness
About Us
Our Leadership
Dr. Vanessa Gourdine, Psy.D, APN-C, CFMP
Dr. Cynthia Orosy, Ph.D.
Locations/Contact Us
Application
Menu of Services
Triparte Organization
Testimonials
Admissions
Free Workshops
Professional Referrals
Insurance & Payment
Make An Appointment
Resources
Ask A Therapist: Question and Answers Survey
Client Satisfaction Survey
Links
Free Services
Blog
Forms
Search for:
Make an Appointment
Home
/
Make an Appointment
Make an Appointment
G4Developer
2023-06-01T19:48:54+00:00
Appointments
Complete the form below and we will contact you as soon as possible.
Name
*
First
Last
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Work Phone
Cell Phone
Email
*
For which services would you like to make an appointment?
Check all that apply
Functional Medicine
Stress Relief Sessions
Individual Therapy
Group Therapy
Family Therapy
Testing and Evaluation
Couples
Workshop
Medication Management
Spiritual Counseling
Other
If you picked Other, please specify
Name of Insurance Company
Insurance Company's Toll Free Number
to verify eligibility or benefits
Name of Insured
Insured's Date of Birth
Insured's Identification Number
Insured's Social Security Number (optional)
Insured's Group Number
Insured's Place of Employment
Relationship to Insured
Your Date of Birth
MM slash DD slash YYYY
Your Social Security Number (optional)
Untitled
First Choice
Second Choice
Third Choice
CAPTCHA
Name
*
First
Last
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Work Phone
Cell Phone
Email
*
For which services would you like to make an appointment?
Check all that apply
Functional Medicine
Stress Relief Sessions
Individual Therapy
Group Therapy
Family Therapy
Testing and Evaluation
Couples
Workshop
Medication Management
Spiritual Counseling
Other
If you picked Other, please specify
Name of Insurance Company
Insurance Company's Toll Free Number
to verify eligibility or benefits
Name of Insured
Insured's Date of Birth
Insured's Identification Number
Insured's Social Security Number (optional)
Insured's Group Number
Insured's Place of Employment
Relationship to Insured
Your Date of Birth
MM slash DD slash YYYY
Your Social Security Number (optional)
Untitled
First Choice
Second Choice
Third Choice
CAPTCHA
Close product quick view
×
Title
Page load link
Go to Top