If you would like to inquire about the availability of a provider, or be placed on a waiting list, please use the form below. Please note that you MUST review the team members and let us know who you would like to work with, as our waiting lists are provider specific.

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We will confirm that we have received your request, and will respond via email at our earliest convenience. Please note that Cultivate does not have an administrative staff, so response times may vary.

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NOTE FOR REFERRING PROVIDERS:

Clients need to contact us directly (using our form or email) to be set up for services. We will not reach out to clients if you send us a referral form, and cannot add records to a chart until a client has started services with us.  Thanks!