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Getting started with Trellis:

Looking for Magnolia Psychiatry?

The 3-step process to begin:

Complete this form and you will be contacted within one business day.
We will schedule a preliminary consultation appointment. This is not therapy, but reserves time and space for us to get to know each other and determine if we are the right practice to meet your needs. This is a 30 minute appointment and requires a $100 reservation fee to schedule.
If we mutually decide to continue, you will be required to complete intake forms digitally through a secure client portal.
* If we’re not the right practice, we will offer referrals to support your connection to care.

Name

First Name

Last Name

Email

Phone

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Is there anything you'd like to share with me prior to our conversation?

Note: Please do not include Personal Health Information in this form.

Legal & Ethical Disclosures:

I understand that Trellis Counseling & Co. PLLC does not offer counseling services for individuals with: Active legal (civil or criminal) investigations, cases, lawsuits, petitions or otherwise. These include active divorce, child custody evaluations, and Child Protective Services Investigations.

Yes, I understand the Trellis practice limitations.

Regarding Minor Clients:

Working with minors in a healthcare setting requires specialized experience and resources. If requesting consultation for a minor, please check all that apply. If this consultation is for an adult (age 18+), please check N/A.

Legal Guardians are divorced

Child is adopted

Child is neurodivergent

Child has a 504, IEP, BIP or other school-system supports

N/A- none of these apply to my child

N/A- Consult request is for an adult client

Financial Disclosures:

Therapy is an investment. Your care should be determined by you and your provider, and not limited based on insurance restrictions. Trellis is out of network with all insurance panels, and has opted-out of Medicare/Medicaid. Provider fees are based on experience, licensure level, and services offered. To learn more about our providers, please click on the "About" tab in the main menu.