Schedule an Appointment First Name Last Name Phone Number May we leave a message at this number? No Yes May we contact you through email? No Yes Email Address How were you referred to us? Primary Care Doctor Friend/Family Member Internet Search Insurance Company College/School Name Other Other I am interested in (hold down 'shift' key to select more than one): Individual Counseling Couples Counseling Family Therapy Assessment Substance Abuse Counseling Other (please specify) Other Which office location do you prefer? Clarkston/Orion Location Troy/Rochester Hills Location Therapist Preference (hold down 'shift' key to select more than one) No Preference Richard Kneip, Ph.D (Clarkston) Kerry Leahy, Ph.D. (Clarkston) Michelle Connelly, M.A. (Clarkston) Claire Benton, M.S. (Clarkston) Holly Workman, MA, LPC, NCC (Clarkston) Kristen Bernat, MA, LPC (Clarkston) Jason Giannini, MA, LPC (Clarkston) Rebecca Anastasi, MA, LPC, NCC (Clarkston) Cheryl Dulude, MA, RN, LPC, NCC (Clarkston) Joseph Shoots, MA, LLP, CAAC (Clarkston and Troy) Sharon Nassau, Ph.D. (Clarkston and Troy) Lynnette Otto, MS, LLP (Clarkston) Tricia Stehle, LMSW (Troy) Antonino Agosta, PsyD, LLP (Troy) Richard Schmalzried, MA, LLP (Troy) Maha Abu-Hamdan, Phd, LLP (Troy and Clarkston) Denise Banyai, MA, LLPC, NCC (Troy and Clarkston) Additional Information When are you available for appointments? Mornings Afternoons Evenings Weekends Insurance Blue Cross PPO BCN HAP Aetna/Cofinity Cigna Medicare Other (Please Specify) Other Enter the code
