Therapist request

Start with a private therapy request.

Share the essentials so Brown Sugar Clinicians can help route your request toward an appropriate care pathway. Use the existing secure request form if you prefer the current intake process.

Care

This is for non-emergency therapy requests. Use the existing secure intake form below if you prefer the current Brown Sugar Clinicians process.

Client information

Share what you can so Brown Sugar Clinicians can follow up with the right care context.

Name required

Email address required

Date of birth if required for routing

Phone number recommended

What brings you here?

Use your own words. A short note is enough to help route the request.

Briefly describe why you are seeking services today.

Previous therapy

Share only what feels useful for routing your request.

No Yes

If yes, briefly describe the type of treatment and approximate date.

Therapy goals

Choose all that apply.

Manage anxiety Cope with trauma Substance abuse Manage depression Work/life stress Self-esteem Grief and loss Other

Other goal or context

Payment preference

Select the option that best matches how you expect to pay for care.

Insurance EAP benefits Self-pay

Need help before sending this request? Call 407-745-6327.