Get Started

Important Note: *

We are currently primarily accepting cash paying clients. Our full fee rate is $200 and we have limited sliding scale spots available. We do not directly bill any insurance companies. For PPOs, the client provides payment and we can provide an itemized receipt to submit for out-of-network reimbursement. Please contact your insurance provider directly to learn about your specific out-of-network benefits.

I understand the financial commitment for therapy ($200 per session).

Your Name

(If you're filling this form out on behalf of a minor)

First Name

Last Name

Is there a custody agreement in place for the client? *

(If you're filing this form out on behalf of a minor)

Yes

No

N/A - Potential client is not a minor

Phone *

(###)

###

####

Potential Client's Name *

First Name

Last Name

Are you interested in therapy or an assessment? *

Therapy

Assessment

Both

Not sure yet

Are you looking for in-person or telehealth sessions? *

Definitely in-person

Definitely telehealth

Undecided

Am open to either option