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Request an Appointment

Please complete this form to request an appointment. If you are submitting the form on behalf of a client, please complete referral information at the bottom of the form. We look forward to helping you on your healing journey!

Contact Phone: 661-522-7255

Email: ewilson@ebonyssafespace.org

*Please allow us 24-48 hours to respond to all appointment request.

Which type of therapy are you seeking? Check all that apply:
Is therapy court ordered? If yes, we must have a copy of the court order on file before services begin.
Would you prefer In-person or Tele-Health Sessions?
Presenting Concerns: Checlk all that apply

Thanks for submitting!

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