Are you seeking care for yourself, or someone close to you? *

Myself

A loved one

A client/patient

Age range *

please note that Aura Art Space does not currently provide care to individuals under the age of 13

Between 13-17 years old

Between 18-30 years old

Over 31 years old

What has been going on recently? *

select al that apply

ADHD

Bipolar Disorder(s)

Borderline Personality Disorder

Chronic Pain

Depression

Generalized Anxiety Disorder

OCD

Panic Disorder

PTSD/Complex PTSD

Self-Harm

Social Anxiety

Other

What type of insurance will be used? *

Commercial/Private

Medicaid

Self-Pay

Other

Name *

if you are inquiring on behalf of a client or loved one, please add your name

First Name

Last Name

Phone *

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###

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By clicking below, I agree to Aura Art Space PLLC's privacy policies and practices *

a copy of our privacy policies and practices can be found at the bottom of this webpage

Yes, I agree