New Clients — Bruce Turnquist & Associates

If you would like to set up an appointment with us, please fill out the form below and then contact us via phone or email.

If you would like us to reach out to you to help set up an appointment, please select “Yes” for the last question in the form below.

New Client Form

Client Type

Client Information

Name (include middle initial after first name)

First Name

Last Name

Email Address

Phone

(###)

###

####

Financially Responsible Party

(if other than Client)

Name

First Name

Last Name

Relationship to Client

Phone

(###)

###

####

Email

Client 2 Information

(only for those interested in couples therapy, please ignore if not applicable)

Name

First Name

Last Name

Email

Phone

(###)

###

####

Please select the primary clinician you would be interested in working with

In brief, please describe the concern or reason that brings you to our practice:

How did you hear about our practice?

I give permission for Bruce Turnquist & Associates to contact me via email or phone to help set up an appointment.