Request an appointment or consultation today!

 

1310 Alford Avenue, Suite 201
Birmingham, Alabama 35226
(205) 979-6822

Hours are by appointment only.

Please fill out the form below and click submit.  Inquiries will be addressed in the order they are received within three business days.  Please do not provide extensive personal/clinical information via this form.  We will discuss details of your case/request via phone or encrypted systems.

Please note that this inquiry form is NOT to be used for emergencies, as it is not monitored 24/7.  If you are experiencing suicidal or homicidal thoughts, or any other mental health emergency, please call the National Suicide Prevention Hotline at 1-800-273-8255.  You may also call 911 or go to your nearest emergency room.

Name *
Name
Phone *
Phone
Please select the reason for contacting Mosaic Wellness.

** Information Collection, Use, and Sharing 
I am the sole owner of the information collected on this site. I only have access to/collect information that you voluntarily give me via email or other direct contact from you. I will not sell or rent this information to anyone. 
I will use your information to respond to you, regarding the reason you contacted me. I will not share your information with any third party outside of my organization.  By submitting your information via this contact form, you are authorizing me to respond to you via the contact information you provide.  By submitting your information through this contact form, you are consenting to utilization of a potentially "non-secure" communication method.