Northern Health and Psychological Services
Judy Hayes Daly ACSW
Board Certified Diplomate

Appointment Form

Judy Hayes Daly ACSW
814 B South Garfield Avenue
Traverse City, Michigan 49686

WWW.SafeHarborNorth.com

Phone: (231) 947-5234 
 Fax: (231) 947-5969
E-mail: nhandps@aol.com

So that we might contact you to determine how we can be of further assistance, please take a few moments to answer the following questions.
  
Note:  Your personal information is strictly confidential. 
First Name
Last Name
City
E-mail  Address (required)
Phone
Alternate or Cell Phone
How would you like us to respond to your request?
E-mail
Postal Mail
Phone
Fax
Personal Appointment
Is it OK to leave an e-mail or voice mail message for you?
Best Time To Reach You?

Important Information or Instructions:  If there is any additional information you would like to share, please use the space below.

The relationship between therapist and client is the single most important factor to a successful outcome in therapy.  For this reason we offer you an initial consultation at no charge.  We will try to get back to you the same day, and may contact you in the evening to give us more time.  Together we can decide  whether counseling or coaching is needed at this point in your life. 

A wide variety of insurances including Medicare are accepted.

Northern Health and Psychological Services
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