Request for Individual, Relationship or Family Services

Intake Form for Individual, Relationship, or Family Services


This form is the first step to receiving INDIVIDUAL , RELATIONSHIP or FAMILY services with Red Maple. This form should be filled out and submitted for prospective clients looking for coaching or psychotherapy services. The pandemic has us very full, so please note: it may take us up to 3 business days to get back to you. We do not provide crisis care. 


Your information is completely secure and will not be shared with anyone outside of our administrative team. 

What service are you seeking?


The process of pairing you with the right professional is more complicated than most realize. It includes a look at that person's area of specialization, experience, waitlist and fees. "Fit" is a critical piece to your growth, and we'd like to get it right, so please help us by providing the following information. 

Thanks for submitting!