Mission
Our Team
Services
Contact Us
What to Expect
Resources
Blog
Request Appointment
Toggle navigation
Mission
Our Team
Services
Contact Us
What to Expect
Resources
Blog
Request Appointment
Contact Us
Send Us A Message
First Name
Last Name
Email
(Required)
Phone
Your Message
OUR LOCATIONS
Email: info@goodlifetherapyia.com
Phone: 515-679-3947 | Fax: 515-349-5301
5000 Westown Parkway - Suite #104
West Des Moines, IA 50266
5435 NW 100th Street - Suite #101
Johnston, IA 50131
Request an appointment
Already a Patient?
Request Appointment
New Patient Appointment Request Form
Please Choose a Provider or a Specialty
(Required)
Choose Care By Provider
Choose Care By Specialty
No Preference
Providers List
(Required)
Anna Zuidema, MA, LMHC, NCC
Adreanne Perkins MSN, ARNP, PMHNP-BC
Jackie Dehner, MA, LMHC, NCC
Emily Elliott, MA, tLMHC, NCC, tCADC
Meredith Stahl, MA, tLMHC, NCC
Deena Leonard, MS, LMHC
Ellen Petersen, MSW, LISW
Erin Knauer, MSW, LISW
Breanne Meisenheimer, MSW, LISW
Daren Jaques, tLMHC, tCADC
Samantha Schwennen, LMHC, NCC, CAdPT
Kimberly Montgomery MSW, LSW
Jenn Demiter, MS, TLMHC
Chad Peters MS, TLMHC
Lisa Weatherwax MSN, ARNP, PMHNP-BC
Rebecca Baker MSN, ARNP, PMHNP-BC
Melissa Wilson MS, TLMHC
Nelly Meyer MS, LMHC
Susan E. Myers MS, tLMHC, CADC
Isaac Dieke, LMSW
Maddie Moree LISW, MSW
Specialties List
(Required)
Individual Counseling
Couples Counseling
PTSD & Trauma
Perinatal Mood & Anxiety Disorders
Telehealth
Play Therapy
Psychiatric medication management
Patient Name
(Required)
First
Last
Patient Date of Birth
MM slash DD slash YYYY
Your Name (if different than patient)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Phone
(Required)
Email
(Required)
When would you like the appointment?
First available
Within the next week
Within the next month
Specific Month
Month
January
February
March
April
May
June
July
August
September
October
November
December
Do you prefer Telehealth or In-person?
Telehealth
In person
Preferred appointment day - select all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred appointment time
Morning - 8am - Noon
Afternoon - Noon - 4pm
Evening - 4pm - 7pm
No Preference
What is the best time for us to call and confirm your appointment?
Morning - 8am - Noon
Afternoon - Noon - 4pm
Evening - 4pm - 7pm
As soon as possible