We're all done!

A Care Manager will be contacting you to set up an appointment with one of our therapists. Please expect a phone call or email during normal business hours, Mon-Fri 9am – 5pm PST.

We're here for you!

You're not alone.

What would you like to talk about?

Let's go through some questions that will help match you with the right therapist.

Tell us a little about what's going on.

Let's go through some questions that will help match you with the right therapist.

Have you received mental health treatment before?

Let's go through some questions that will help match you with the right therapist.

What are your current goals for treatment?

Let's go through some questions that will help match you with the right therapist.

Do you have a diagnosed medical condition?

Let's go through some questions that will help match you with the right therapist.

What has your employment been like in the past 5 years?









The following information will help us match you with a therapist quickly.

Client Information

The following information will help us match you with a therapist quickly.

Insurance Information

I have read and accept Fusion Care Group's Telehealth consent.

I have read and accept Fusion Care Group's Treatment Consent form.

I have read and accept Fusion Care Group's Privacy Policy.

I understand that by typing my name I am electronically signing this document.

Click the Submit button to send the data entered on this form to Fusion Care Group.

Click the Cancel button to exit the form without saving or sending the data entered.