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African American Couple

INTAKE APPOINTMENT REQUEST

Please note: All Fall session groups are full at this time and we have very limited space for January 2019. We would like to refer you to our Links and Other Resources page for a list of alternate resources. If you would like to be added to our interest list, please fill out and mail our registration form c/o Karrin Grutz at Wallys Play Groups. If we have your form, we can contact you when something appropriate opens up.
 
*We are not currently scheduling intake appointments* To schedule an intake appointment or "structured playdate", or to obtain additional information about any of these services, please fill out the form below.
 

The cost of this initial appointment is $100.00 to be paid by date of service. To make a payment click here. Intake appointments can be scheduled on most Tuesdays or Thursdays.
 
Please do not include confidential or private information in this form or any other form found on this website. This form is for general questions or messages to the practitioner. Email may contain client identifiable or confidential information. Because email is not secure, please be aware of associated risks of email transmission. Communication via email implies your agreement to accept the risks of email communication. 

 

 

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.