Counseling Appointment Request

To request an appointment with a JFS specialized therapist, please complete the form below.

Once the form is submitted, our intake coordinator will contact you within two business days to complete all required paperwork. (Please note: Our counseling office hours are Mon – Thurs 8am – 5pm, excluding holidays). Once your paperwork is completed, a therapist will be assigned to you based on your specific needs and the therapists specialization and availability.

(If you would prefer to request an appointment on the phone, please call (407) 644-7671)

Please note: You may only request an appointment for yourself or on behalf of your child (age 17 and under), your client if you are a provider, or your partner if inquiring about couples therapy. All other requests must be completed by the client seeking counseling themselves.
Please enter a few days of the week and times you are available and we will do our best to find a time that works.
Please note: Friday and Saturday appointments are very limited.
Please list any preferred therapist specialties or qualities. Although some therapists might have full case loads and are not accepting new clients, we will do our best to accommodate your request.
Please describe the reason for which you are seeking a counseling appointment.

Please note: This form is not a means to communicate directly with a therapist.

If this is an emergency, please call 911.

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