Contact us — Flourish Wellness Collective

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 *

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Preferred Method of Contact *

What are you seeking support/resources for at this time? *

If applicable, what insurance are you submitting? *

What days and times work best for you to attend appointments? *

Do you want to work with a specific provider?

If there is a provider who you believe might be able to best support your individual needs, please let us know!

Lauren Scafe

Taryn Zweygardt

Jennifer Gunn

Riley Blanton

Jennifer Azar

Sara Stimatze

Stacie Watts

Kelsey Barnickle

Lauren Gilley

Karis Rozof

Dr. Heather Rogers

Katie Miles

Tiffany Harlan

Would you be open to seeing a student therapist? *

Our licensed therapist sometimes have waitlists for new clients and our student therapists may be able to provide support sooner. This is also a great option for people who do not have insurance or have a plan with large out of pocket expenses.

Yes

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!

Thank you for contacting us! We do our best to get back to you within 24-48 business hours!

If you are in need of immediate support, please call 911 or visit your nearest emergency room. For non-urgent needs, you can call/text the National Maternal Mental Health Hotline at 1-833-852-6262. The National Maternal Mental Health Hotline provides 24/7, free. confidential support being, during and after pregnancy.

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Email Address

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Thank you!

The use of this website does not imply nor establish any type of therapist-client relationship. Furthermore, the information obtained from this site should not be considered a substitute for a thorough medical and/or mental health evaluation by an appropriately credentialed and licensed professional.

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

Phone: (316) 766-6341
Fax: (316) 330-5507
flourishwellnesscollectiveict@gmail.com