Fill out the form to REQUEST AN APPOINTMENT. A KSBH team member will contact you as soon as possible to confirm your appointment. If you are having an emergency, go to the ER or call 911. Name(Required) First Last Email(Required) Phone(Required)Preferred contact method(Required)EmailTextCallPreferred time to be contacted(Required)MorningAfternoonEveningWhat service(s) are you interested in?(Required) Individual Therapy Family or Couples Therapy Life Skills Family Skills Tailored Intensive Outpatient I'm not sure What concerns are you experiencing?(Required)HiddenURL PhoneThis field is for validation purposes and should be left unchanged. Δ