Behavioral Health Appointment Request

Please review and complete this form to request an appointment.

    Thank you for your interest in Intuition Wellness Center. Here is some information that may be helpful:

    • Intuition Wellness Center serves individuals ages birth to 25 and their caregivers.
    • Some services are billable to Blue Cross Blue Shield and Aetna insurances; however, not all team members are on insurance panels.
    • Self pay fees for services are available to view on our Fee Schedule.
    • Intuition Wellness Center’s training department consists of supervised PhD students and masters-level clinicians who are seeking a higher level of licensure. The training department provides services at a reduced fee. Typically, these services are not billable to insurance. See benefits to working with out training department
    • Team members at Intuition Wellness Center have limited availability. Prospective clients with flexibility of scheduling and team member preference are the most successful in matching to services.
    • The Intuition Wellness Team values a thoughtful process when it comes to matching potential behavioral health clients with a provider. It typically takes 3-7 business days for the team to formulate a response to requests for an appointment. Occasionally the wait may be a bit longer, such as during holidays or times when the volume of requests is particularly high. Thank you for your patience.
    • If you are seeking information on our Wellness Programs, you are not required to complete the following questionnaire.
    • The questionnaire below is required in order to determine Intuition Wellness Center’s ability to meet your needs for clinical services. If you have questions, please call 520-333-3320:









      Self (adult)ChildFamily





      MaleFemaleOther










      BCBSAetnaPsychology TodayInternet (eg., Google)PCPOther ProfessionalOther



      Any Licensed Team MemberSupervised Doctoral Student or Clinician Pursuing Higher LicensureSpecific Team Member



      CounselingPlay TherapyParent GuidanceFamily TherapySchool Success Consultation





      Eating DisorderAddictionNone of These



      YesNo



      YesNo



      YesNo



      YesNo
      (If so, please call 911 or the crisis line at 1-866-495-6735 to speak to a crisis counselor.)



      YesNo



      YesNo



      YesNo
      (If so, please call the crisis line at 1-866-495-6735 to speak to a crisis counselor or call 911.)



      YesNo



      YesNoNA, prospective client is an adult



      YesNoNA, prospective client is an adult



      Please supply supporting court documents at intake or scan and email them to contact@intuitionwellness.com prior to your intake appointment.



      MedicalBehavioral HealthOtherNone


      If you have previous behavioral health or medical treatment history, please bring a copy of records (e.g., treatment summary, treatment plan, testing reports, etc) at the initial intake appointment. You can also email PDF documents to contact@intuitionwellness.com.



      Self Pay (Licensed Team Member)Self-Pay (Training Department Reduced Fees)BCBSAetna


      If you choose Insurance payment, please provide the following information for insurance verification (Please note that some services are not billable to insurance):





      Prospective testing clients only:


      NoYes



      NoYes


      Thank you for taking the time to complete the questionnaire. Please click “Request an Appointment” to submit to the Intuition Wellness Center team for review and processing. It typically takes 3-7 days for the team to review requests and formulate a response. Intuition Wellness Center receives many requests each week. If caseloads are full, you will be given other referrals.