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OUR PRACTITIONERS:
Aubrey K. Ewing, PhD
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Make an Appointment
Patient's last name:
*
Patient's first name:
*
Date of birth: (MM-DD-YYYY)
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Insurance carrier:
Insurance authorization number:
Telephone: (xxx-xxx-xxxx):
*
Email:
Service requested:
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Individual counseling
Child, teen, or family therapy
Marital or relationship counseling
AD/HD Evaluation
Educational or psychological testing
Biofeedback or neurofeedback
Uncertain - please call
Select the doctor/therapist you wish to see:
Aubrey K. Ewing, Ph.D.
Karen Ponder, MSW, LCSW
Pamela Klinger, M.Ed., LMHC
Leslie Zucker, MSW, LCSW
Jennifer Valentine, Ed.S., NCSP
Danielle Shrank, MA, MS, Psy.S.
Rebecca Matte, MS, LMFT, NCC
Any male therapist
Any female therapist
No preference
I am a new patient:
Yes
No
I prefer these times:
No Preference
Morning
Afternoon
Evening
I prefer this day:
No Preference
Weekday
Saturday
Verification Code
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Please add 5 and 7.
