Fill out the form to request a telehealth appointment Name *Date of Birth *Email Address *Phone Number * Text and Phone Call Disclaimer In order to provide you with a virtual intake appointment, we will have to text you online forms to fill out, along with a link to access the virtual appointment. If you are not comfortable with us contacting you via text, please exit this form and call us directly at 419-578-7351. Preferred Telehealth Appointment DatePreferred Telehealth Appointment TimeMorningAfternoonEveningComments/QuestionsSend Message
