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CONTACT US

We’d love to hear from you — reaching out is the first brave step toward feeling better and finding lasting support.

Let’s talk about how we can help you and/or your family thrive.

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You are important to us! You can expect returned contact within 24 business hours.

First Name

Last Name

Phone

Age

Service(s) of Interest: * Required

Individual Therapy

Adolescent / Teen Therapy

Couples Therapy

Family Therapy

Couples Intensives

Groups / Workshops

Interest in Free Groups Offered:

Relationships 101: Virtual, Next group meets 4/22, 4/29, 5/6 (Wed 6-7p)

Stress & Anxiety Skills Group for Teens: Virtual, Next group meets 4/29, 5/6, 5/13 (Wed 4:30-5:45p)

Motherhood: From Reactive to Regulated -- Virtual, Next group meets 4/14, 4/21, 4/28 (Tues, 7-8:15pm)

Therapist(s) of Interest:

Leah Marcusen

Sydney Erickson

Haley Bergstrom

Samantha Bernard

Heather Hoskin

Dr. Rachel White

I'm Not Sure

Payment for Services * Required

Private Pay

Aetna

Cigna

Lyra

Compsych (Tiger Act)

Intern Rates ($20-40/session)

First Responder Benefits (EAP or Tiger Act)

I would like more information

Other

I'm Working On:

Anxiety

Depression

OCD

Relationship Issues

Infidelity

Parent-Child Relationship Issues

First Responder / Military Issues

Perfectionism / People-Pleasing

Burnout / Overwhelm

Grief / Loss

Life Transitions / Adjustment

Self-Harm

Trauma

Workplace Issues

Other

Indicate Preferred Days / Times:

Mornings

Evenings

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

How Did You Hear About Us? * Required

I am a previous patient

Friend / Co-Worker

Therapist

Doctor / Psychiatrist

TikTok

Instagram

Facebook

Church

Public Safety Crisis Solutions

Other

Message

If seeking couples therapy, please include the full name and email address of your partner. When scheduling, you both will receive access to complete the intake forms.

If seeking therapy for a minor, please include the full name and email address of the other parent.

Thank you! Please look for our EMAIL or PHONE contact within the next 24 hours!

Completing this form also adds you to our info system, allowing you to remain up-to-date with info about our practice & providers.

17505 N. 79TH AVE., SUITE 308,

GLENDALE, AZ 85308

623-887-3636

RESTORATION

PSYCHOLOGICAL SERVICES

Helping individuals and relationships heal, grow, and thrive compassionate, evidence-based care.

CONTACT

QUICK LINKS

17505 N. 79TH AVE., SUITE 308
GLENDALE, AZ 85308

DrRachelWhite@RestorationPsychServices.com

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623-887-3636

CONTACT US

You are important to us! You can expect returned contact within 24 business hours.

Completing this form also adds you to our info system, allowing you to remain up-to-date with info about our practice & providers.

RESTORATION

Helping individuals and relationships heal, grow, and thrive compassionate, evidence-based care.

CONTACT

QUICK LINKS

About

Services

Articles

FAQ

Contact

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