Request an Intake

We require an initial intake before attending groups at The Healing Center. This first connection is an important beginning to the healing process as it serves as an introduction to our services and opportunity for us to get to know you and your needs.

Please fill out the form below to request an intake. We will follow up within 48 hours. Please note that due to privacy laws, we cannot accept intake requests that are made on behalf of another person, unless the individual is under 18. 

Request An Intake
Enter the name of the person seeking services, if not the same as above
Select your relationship to the person seeking services, if not yourself
You can select more than one option
Please select which group you are interested in attending. If you are unsure, please visit to learn more about our groups or leave this field blank.