Request appointment | Tarah Galloway, LCPC, ATR

Request an appointment

What is the reason you're seeking therapy?

Please be as detailed as possible about what is bothering you.

Is there a particular type of therapy you're interested in?

Please write below (i.e. EMDR, Expressive Art Theraspy, Cognitive Behavioral Therapy, Parts work, Somatic, etc)

What mental health concerns or treatment have occurred recently or in the past?

Select all that apply

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.