Leek Therapy – Internal Support Request Form (Staff Use Only)

Purpose: This form is for internal staff to request assistance, report issues, or ask questions related to daily operations, tech support, administrative concerns, or clinical guidance. Your submission will be routed to the appropriate person (e.g., Matt Wake, Alex Kania, Amy Leek) based on your selection.

Your Information

First Name

Last Name

Leek Therapy Email Address *

Type of Support Needed

What do you need help with?

Technical Issue (email, calendar, SimplePractice, GHL, etc.)

Clinical or Client Care Question

Scheduling or Availability Support

HR or Payroll Concern

Policy or Process Clarification

Something Else

Describe the Issue or Concern

Please describe the issue or question in detail so we can assist you efficiently.

Attach a Screenshot or File

Upload any file or screenshot that may help us understand the issue.

Preferred Follow-Up Method

Please select your Preferred Follow-Up Method

G-Chat

Schedule a quick call