Waitlist Form

A person working at a desk with a laptop, a white coffee mug, and a green leafy plant in the foreground.

Please fill out out the information below. We will contact you when there is availability that aligns with your schedule. Average waitlist time is 1-2 months.

Name

First Name

Last Name

Subject

Message

Availability

Frequency

Setting

If you are having a mental health emergency go to your nearest ER or call RHA mobile crisis available 24/7

RHA Mobile Crisis 1-844-709-4097

Link to regional hotlines here

Name

First Name

Last Name

Subject

Message

Appointment Availability

Available times and days for sessions

Frequency of Sessions

Insurance Plan

Location

201 N Front Street Suite 513

Wilmington, NC 28401

Phone Number

910-523-2466

Fax number

( 910) 994-4870