Request Appointmentphone: 919.594.6510 fax: 919.666.0039 102 Towerview Ct., Cary, NC 27513 Request an Appointment Please note that this form is to be used for non emergencies only. We ask that you allow our office 48 business hours to contact you back. Thank you! Name* First Last Phone*Email* What service are you inquiring about?Select...CounselingGenetic TestingEMDRAre you a New or Existing Patient?*Select...New PatientExisting PatientReferring Practice/Counselor/Physician NP or PA* Insurance:* Self-pay Aetna Cigna Medcost Optum/United Requested Appointment Date* MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged.