Contact us — Flourish Wellness Collective

Contact us.

Fax: 316-330-5507

10209 W. Central Ave, Suite 1
Wichita, KS 67212

Filling out and submitting this form is not a guarantee of service and does not in any way guarantee that services will be provided by Flourish Wellness Collective members or ambassadors. This form should NOT include any sensitive or personal information including (but not limited to): birthdate, medical history, social security number, home address, etc.

By filling out and submitting this form you agree to be contacted by Flourish Wellness Collective regarding the options selected and/or described.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Preferred Method of Contact

What are you seeking therapy for at this time?

If applicable, what insurance are you submitting?

What days and times are you available for therapy?

Do you want to work with a specific provider?

Do you prefer in person or virtual appointments?

In Person

Virtual

Either is fine

How did you hear about us?

We value the relationships and connections that bring clients to us. Knowing who referred you helps us recognize and thank those who have guided you to our services!