Get Services

Services

Therapy Application

Please fill out the form below and we will get back to you ASAP.

Success
Thank you! Form submitted successfully.
This field is required
This field is required
This field is required
  • Montgomery
  • Greene
  • Clark
  • Champaign
  • Miami
  • Preble
  • Butler
  • Warren
  • Clinton
  • Shelby
  • Logan
  • Darke
This field is required
  • Yes
  • No
This field is required
  • Yes
  • No
This field is required
  • Yes, I am currently receiving treatment for PTSD
  • No, I am not yet in treatment for PTSD
  • No, but I think I would benefit from treatment for PTSD
  • I have completed treatment for PTSD
  • Never occurred to me
This field is required