Online Consultation

Complete our online consultation below. We will review your information, contact you shortly, and match you with a therapist who fits your needs.

Name

First Name

Last Name

Phone

(###)

###

####

Have you been in therapy before? If Yes, How long?

Do you have a preference for the type of therapist you would like to be paired with?

What days and times work best for therapy sessions?

Are you currently taking any mental health medications?

Are you currently under the care of a Psychiatrist?

Have you been hospitalized within the last six months?

Will you be using your health insurance to cover therapy sessions or will you self pay? If using insurance, please state the insurance carrier name (Aetna, BCBS, Oscar etc)

If you are self paying, are you in need of a sliding scale fee? Please consider paying the full amount. It allows us to offer a sliding fee to those who are in need of it.

Thank you for completing this online consultation. You can add any questions you may have below. We will be in touch shortly to schedule your first therapy session.

Who referred you to our practice?

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Online Consultation

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