Fill out the short questionnaire to help us hit the ground running on our call ⬇️

Fill out the short questionnaire to help us

hit the ground running on our call ⬇️

What is your gender?

Man

Female

Prefer not to say

Will you be using insurance?

Yes, if yes name of insurance carrier

No, if no are you using Employee assistance program ( EAP) or private pay?

Please enter the name of your insurance carrier.

Please enter if you’ll be using EAP or Private Pay.

Do you prefer virtual, in-person, or both sessions?

Virtual

In-person

Both

Please briefly tell us what is bringing you to therapy at this time in life?

You have completed the questionnaire!

Let's get you scheduled

First name

Last name

Phone

I agree to the Privacy Policy and Terms & Conditions provided by the company. By providing my phone number, I agree to receive SMS messages from the business regarding services and scheduling.