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About
Schedule a Session
Schedule a Consultation Session
Please complete the form below to inquire about a free 20 minute intake consultation session
Name of Intended Client
*
First Name
Last Name
Phone
(###)
###
####
Email
*
Type of Service
*
Use the drop-down menu to select the type of counseling you want.
Family Therapy
Couple Therapy
Individual Adult Therapy
Individual Teen Therapy
Child Therapy 6-11 Years Old
Child Therapy Under 6 Years Old
Brief Description of the Issue
*
Please include a brief description of your issue you want help with
Health Insurance Coverage & Private Pay
What type of insurance / payment methods do you have?
Medical
Medicare
No Insurance/Private Pay
Blue Shield PPO
Other Private Insurance (Superbills available for you to submit out of network benefits)
Thank you!
