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757-788-2800 info@relationship-center.com

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Booking a session is quick and easy. Fill out the form below to request your session, and we’ll get back in touch with you to schedule your time.

Name*
First Last
Phone*
Email*
Who are you looking to get help for?*
- Tween/Teen (13-17)
- Adult
- Family/Parenting
- Couple/Relationship
- Other
Please Specify
What type of relational support are you looking for?*
- Premarital Counseling
- Couples Therapy
- Couples Therapy for Betrayal
- Discernment Counseling – when one or both partners are considering divorce
- Individual Therapy for Relationship Issues
- Family Therapy
- Sex Therapy
- Step Parent & Step Family
- Trauma Therapy & EMDR
- Gender Identity
- Equine Therapy
- Chronic Illness of Self or Family Member
- Perinatal Maternal Health
- Other
Please Specify
Which therapy option works better for you?*
- In-Person Sessions
- Online/Telehealth Sessions
- Norfolk Office
- Williamsburg Office
Do you have a preferred therapist in mind
- Yes
- No
Which therapist?
What method of payment do you plan to use?*
Please note we ONLY take Optima and Anthem BC/BS. Not all Therapists take insurance. Any use of medical insurance requires a medical diagnosis – to understand more (add link to rates page explaining use of insurance benefits).
- I will be paying out of pocket
- I plan to use my out of network insurance benefits
- I will be using my medical insurance benefits
How did you find out about us?
- Internet Search
- Facebook
- Physician
- Friend
- Church
- Insurance company
- Psychology Today
- Other
Please Specify
If you were referred, who can we thank?
Finally, any special considerations that will help us help you?
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Name
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4615 Pleasant Ave, Suite B
Norfolk, VA 23518
757-788-2800

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