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Schedule an Appointment

Ready to schedule an appointment? Fill out a request form and we will get back to you as soon as possible.

Preferred Location

Bloomington • Main Bloomington • Madison

Client Name*

Guardian Name

Date of Birth

Best Way to Contact You

Email Phone Text

Email*

Phone*

Reason for Services

Insurance Provider

Member ID#

Preferred Therapist(s)

Ashley Albin Stephanie Blandford Kait Brummett Sydney Conger Alisa Doty Maddux Eylander Kyle Fouch Hannah Gill Beki Hilas Chi-Wei “Diana” Kan Cheryl Mansell Kaitlyn Merwin Angie Miller Kevin Moore Haylie Romer Liz Sickels Adrienne Watkins Bethany Williams

Who Referred You?

Locations

Bloomington • Main

mainoffice@newoutlookcc.org

5010 N Stone Mill,
Suite B,
Bloomington, Indiana, 47408

Bloomington • Madison

btownoffice@newoutlookcc.org

501 S. Madison St.,
Suite 105,
Bloomington, IN 47403

Cheryl L. Mansell

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Bloomington • Main

5010 N Stone Mill Suite B
Bloomington, Indiana, 47408

Phone: 812-929-2193
Email: mainoffice@newoutlookcc.org
Fax: 888-789-8394

Bloomington • Madison

501 S. Madison St, Suite 105
Bloomington, IN 47403

Phone: 812-929-2193
Email: btownoffice@newoutlookcc.org
Fax: 888-789-8394

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