Intake Request Name * First Name Last Name Email * Phone * (###) ### #### How did you hear about Rosewood Integrative Counseling? * What has brought you (or your child/friend/family) to counseling at this time? * Who are you requesting an appointment for? * Myself My child A family member A friend If you are scheduling an appointment for a person other than yourself, please share their name below: First Name Last Name If you requesting a specific therapist, please select their name below: Camilla Bradley, MA Cara Joyner, LPC Leslie Brown, LCSW Lindsay Growhowski, M.Ed. Nowoola Awopetu, MS, NCC Nychelle Thompson, MA Tracie Ferguson, LPC, NCC Thank you! A clinician from our team will be in touch within the next 48 hours.