Request appointment | Solace Counseling PLLC

Request an appointment

Insurance Company

(Please list name of insurance as it appears on your insurance card)

Insurance card upload

Upload a photo of your insurance card

Member ID

Please type exactly how it appears on your insurance card

Mailing Address

Billing Address

Are you the policy holder?

Yes No

If you are not the policy holder, please list the first name, last name, relation to the client, date of birth, gender, phone number, mailing address, and billing address of the policy holder.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.