Fill out the short questionnaire to help us match you with the right therapist.⬇️

Fill out the short questionnaire to help us

match you with the right therapist. ⬇️

What is your gender identity?

How old are you?

How old are you? couples*

What is your date of birth?

Will you be using insurance for your sessions?

Provide your Insurance information:

1. Name of your insurance carrier,

2. Member ID #,

3. Customer Service Phone number on the back of the insurance card.

*** we will verify your insurance and let you know of any client payment responsibility. *** please remeber to send a copy of the front and back of your insurance card to our office via email or text

Will you be starting Services with your EAP benefits? If So,

1. Name of your Employee Assistance Provider?

2. Authorization # and how many sessions authorized

3. EAP provider phone number?

4. Do you have a preference Male or female therapist?

5. Best days and time for appointment?

6. Virtual or in office sessions?

  1. Do you have a preference Male or female therapist?

  2. Best days and time for an appointment

  3. Virtual or in office sessions?

Please tell us briefly, what brings you to therapy at this time in your life?

You have completed the questionnaire!

Let's get you scheduled for a complementary 15-minute consultation with one of our team members

NEXT

What is your gender identity?

How old are you?

How old are you? couples*

What is your date of birth?

Will you be using insurance for your sessions?

Provide your Insurance information:

1. Name of your insurance carrier,

2. Member ID #,

3. Customer Service Phone number on the back of the insurance card.

*** we will verify your insurance and let you know of any client payment responsibility. *** please remeber to send a copy of the front and back of your insurance card to our office via email or text

Will you be starting Services with your EAP benefits? If So,

1. Name of your Employee Assistance Provider?

2. Authorization # and how many sessions authorized

3. EAP provider phone number?

4. Do you have a preference Male or female therapist?

5. Best days and time for appointment?

6. Virtual or in office sessions?

  1. Do you have a preference Male or female therapist?

  2. Best days and time for an appointment

  3. Virtual or in office sessions?

Please tell us briefly, what brings you to therapy at this time in your life?

You have completed the questionnaire!

Let's get you scheduled for a complementary 15-minute consultation with one of our team members

NEXT