Book Appointment

Fill out the detailed form below with the most accurate information and our team will get back to you shortly.

Send us a message

Let’s Connect – Personalized Care for Your Well-Being

Experience Professional, Compassionate Mental Health Services are designed to fit your unique needs and lifestyle.

Let's Talk

Phone : 704-727-7008

Fax

704-774-6922

Email Support

info@well-balancedsolutions.com

Office Hour

Monday - Thursday
09.00 am - 05.00 pm

Offices

-999 Waterside Drive, Ste 2525, Norfolk, VA 23510 -2015 Ayrsley Town Blvd, Ste 202, Charlotte, NC 28273

Follow social media

999 Waterside Dr, Suite 2525 Norfolk, VA 23510

2015 Ayrsley Town Blvd, Suite 202 Charlotte, NC 28273

Full Name

Phone

Appointment Date

Date of Birth

Address

Apt/Suite/Other

City

State

ZIP Code

Insurance Carrier

Insurance Member ID

Group Number

What services are you interested in?

Reason For Visit

Current Psychiatric Medication History

Previous Psychiatric Medication History

How did you hear about us?

Drivers License Front

Drivers License Back

Health Insurance ID Front

Health Insurance ID Back

By checking this box, I consent to receive conversational and customer care SMS from Well-Balanced Solutions. I understand that message frequency varies and data rates may apply. I understand that I may opt-out by replying "STOP" at any time. I understand that I may reply "HELP" for assistance. I agree with the Privacy Policy and Terms and Conditions.