Let's Find Your Right Fit

Share a few details and we'll match you with a clinician suited to your needs, location, and schedule — every match is reviewed by our team before you're connected.

If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or 911 for emergencies. This form is not for crisis support.

Safety Check-In

This helps us make sure you get the right level of support.

Are you currently having thoughts of harming yourself or others? *

Basic Information

Full Name *

Date of Birth *

Gender

Phone *

Email *

Emergency Contact Name

Emergency Contact Phone

Preferred Location *

Address

Used for billing and correspondence

Street Address *

City *

State *

ZIP Code *

Who Are Services For?

Care Preferences

Used to match you with the right clinician

Insurance Provider *

Member ID

Group Number

Subscriber or Dependent?

Schedule Preferences *

Select preferred days and time blocks for appointments

What Are You Seeking Support For? *

Select all that apply

Treatment History & How You Found Us

Prior Treatment History

How did you hear about the practice?

Anything Else?

Share any additional information you'd like us to know

Consent*

I consent to The Thrive Network using this information to match me with a clinician, and sharing it only with The Thrive Network staff and my matched provider.