Appointment Request | Headspace Counseling

Home
About us
Our Services
Meet the Team
Getting Started

Take the First Step...

Please fill out the form below, and we will contact about scheduling.

First Name and Last Name

Date of Birth

Your email*

Phone Number

Which days of the week are you available for therapy?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Who is your primary insurance carrier?

Blue Cross Blue Shield

Blue Care Network (BCN)

Meridian/ Blue Cross Complete

Private Pay

Optum/United Health Care

Aetna

McLaren

Other:

What concerns are you wanting to work on in therapy?

Paragraph

Address

411 W Lake Lansing Rd, Suite B 110
East Lansing, MI 48823

Notice of Privacy Practices

No Surprises Act

You have the right to receive a Good Faith Estimate of what your services may cost.

Contact

517-657-3533
services@headspace-counseling.com