Appointment Request Form

Appointment Request Form

Please complete the information below. A Child Guidance staff member will follow up with you within 1-2 business days.

Please check all that apply.
Not all services available at all locations.

We will take reasonable precautions to prevent the loss, misuse or alteration of your personal information. However, data transmission over the internet is inherently insecure, and we cannot guarantee the security of data sent over the internet. If you do not wish to transmit your information electronically, you can call 918-594-4720 to speak to a Child Guidance staff member.