Intensives Contact

Request for Intensive Therapy Intake

This form is ONLY for requests for intensive therapy retreats (not for ongoing therapy). If you are looking for ongoing/weekly therapy, please click here. Intensive therapy is not appropriate for crisis situations. If you are at risk of self-harm please call 911 immediately.

We have become aware that not all submissions through our website are reaching us, and we are working to resolve this issue. Please know, we respond to all inquiries. If you do not receive a response within 5 business days, please call us!

I acknowledge that this form is ONLY for requests for intake for Intensive Therapy Retreats, which are not billable to insurance. By submitting this form I agree that I have read the information on Intensive Therapy Retreats, and the FAQ page for Intensive Therapy Retreats, and believe that an intensive therapy retreat may be a good fit for my needs. I understand that WellSpring will not be able to respond to other inquiries. *

I agree

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Were you referred to a specific provider? *

No, I was not referred to a specific provider Yes, I was referred to a specific provider

If you were referred to a specific provider, please let us know who you would like to see: *

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