You can always press Enter⏎ to continue
Find The Right Therapist
This brief questionnaire will take about 5 minutes to complete.
Start
Language
English (US)
1
What kind of therapy are you interested in?
*
This field is required.
Individual Therapy
Couples and Relationship Therapy
Family Therapy for Children (Adolescents and Teens)
Counseling for Entrepreneurs
Group Therapy
College Counseling
Co-Founders Therapy
Previous
Next
Submit
Press
Enter
2
Are you interested in learning more about any of the following groups?
Select as many as you like
Dialectical Behavior Therapy (DBT) Skills Group
Trauma Processing Group
Trauma Skills Group
Previous
Next
Submit
Press
Enter
3
What areas would you like to work on in therapy?
*
This field is required.
Anxiety & Significant Life Changes
Depression and/or Negative Feelings
Trauma or Traumatic Experiences
Relationships with Friends, Family, and Partners
Concerns About Health
Academic/Career Stress or School/Work Transitions
Concerns About Race or Social Injustice
Concerns About Gender or Sexuality
Cultural Identity/Exploration
COVID-19/Pandemic-Related Stress
Life in General
Previous
Next
Submit
Press
Enter
4
Please tell us about you and what you're hoping to work on in therapy.
*
This field is required.
The more details you share, the more personalized recommendations we're able to provide.
Previous
Next
Submit
Press
Enter
5
Are there any specific qualities or characteristics you're looking for in a therapist?
(I.e. "I prefer a therapist with lots of life experience who is more directive" , "I have a lot to share most of the time, I want someone who listens deeply.")
TextSize
Created with Sketch.
Huge
Large
Normal
Small
Bold
Created with Sketch.
Italic
Created with Sketch.
Underline
Created with Sketch.
Underline Copy
Created with Sketch.
Ok
NumberList Copy 2
Created with Sketch.
quote
Created with Sketch.
Break
Created with Sketch.
Image
Created with Sketch.
Ok
Smiley
Created with Sketch.
Previous
Next
Submit
Press
Enter
6
Is this your first time seeking therapy?
*
This field is required.
Yes, I'm new to therapy
No, I've been in therapy before
Previous
Next
Submit
Press
Enter
7
Are you interested in a specific type of therapy?
(I.e. "I'd like to learn about treatment for anxiety," "I want something more structured that provides homework like CBT")
TextSize
Created with Sketch.
Huge
Large
Normal
Small
Bold
Created with Sketch.
Italic
Created with Sketch.
Underline
Created with Sketch.
Underline Copy
Created with Sketch.
Ok
NumberList Copy 2
Created with Sketch.
quote
Created with Sketch.
Break
Created with Sketch.
Image
Created with Sketch.
Ok
Smiley
Created with Sketch.
Previous
Next
Submit
Press
Enter
8
Would you like your therapist to have expertise in certain areas?
Select all that may apply
Anxiety
Depression
Family Issues
Grief and Loss
Counseling for Entrepreneurs and Creatives
BIPOC and/or Race-Related Concerns
Trauma or Traumatic Experiences
LGBTQIA+
Sex Therapy and/or Sex and Intimacy Concerns
Young Adult Concerns
Women's Issues
Men's Issues
Mindfulness/Meditation
Religion/Spirituality or Existential Concerns
Yoga and/or Mind-Body Approaches
Acculturation/Immigration
Previous
Next
Submit
Press
Enter
9
Are you interested in any of the following therapy approaches?
Eye Movement Desensitization and Reprocessing (EMDR) Therapy
Cognitive Behavioral Therapy (CBT)
Psychodynamic Therapy (Insight-Oriented Therapy)
Dialectical Behavior Therapy (DBT)
Emotion-Focused Therapy (EFT)
Internal Family Systems (IFS)
LGBTQIA+ Affirmative Therapy
Sex Therapy
Somatic Therapy (Including Yoga & Meditation)
Previous
Next
Submit
Press
Enter
10
Therapists at our practice not in-network with any insurance panels. However, if you have out-of-network benefits, your insurance may reimburse you. We'll be happy to check on this for you.
Your insurance company typically will reimburse you directly after you've met your deductible. We provide courtesy billing and can submit claims on your behalf.
I'd like to learn more about using my out-of-network benefits
I'd like to pay out of pocket
Previous
Next
Submit
Press
Enter
11
Therapists at our practice are not in-network with any insurance panels. However, if you have out-of-network benefits, your insurance may reimburse you. We'll be happy to check on this for you.
Your insurance company typically will reimburse you directly after you've met your deductible. We provide courtesy billing and can submit claims on your behalf.
I'd like to pay out of pocket
I know that my out-of-network benefits will cover therapy
I'd like to learn more about using my out-of-network benefits
Previous
Next
Submit
Press
Enter
12
Our therapists charge market rate for therapy sessions, with some offering a limited amount of sliding scale. Fees range from $125-$400, depending on the therapist. Please select all of the fee ranges that you're comfortable with.
*
This field is required.
Most PPO insurance plans provide reimbursement for out-of-network services once you meet your deductible. We typically see reimbursements ranging from $50-$250 per session. The actual amount you receive will depend on your plan.
$125-$175
$175-$225
$225-$275
$275-$325
$325-$350+
Previous
Next
Submit
Press
Enter
13
-
Many insurance plans provide reimbursement for out-of-network services once you meet your deductible. We’re happy to try to help you find out what that reimbursement might look like.
$125-$175
$175-$225
$225-$275
$275-$325
$325+
Previous
Next
Submit
Press
Enter
14
I prefer to meet my therapist:
*
This field is required.
No preference
In person
Virtual/Telehealth
Hybrid
Previous
Next
Submit
Press
Enter
15
How important is it to you to find a therapist who meets this criteria?
*
This field is required.
Not very important
Somewhat important
Neutral
Important
Extremely important
Not very important
Somewhat important
Neutral
Important
Extremely important
Previous
Next
Submit
Press
Enter
16
What times work best for therapy sessions?
*
This field is required.
Anytime between 9am-5pm on weekdays
Before 9am on weekdays
Only after 5pm on weekdays
Weekends work best for me
I’m flexible
Previous
Next
Submit
Press
Enter
17
I prefer a therapist who identifies as:
*
This field is required.
Although we don’t currently have therapists who identify as Non-Binary or Transgender, we can gladly refer you to a therapist who does identify as such. All of our therapists are Non-Binary and Transgender-affirmative.
No preference
Male
Female
Non-Binary
Transgender
Previous
Next
Submit
Press
Enter
18
Is it important to you that your therapist identifies as BIPOC?
*
This field is required.
Yes
No preference
Previous
Next
Submit
Press
Enter
19
Is it important to you that your therapist identifies as LGBTQIA+?
*
This field is required.
Yes
No preference
Previous
Next
Submit
Press
Enter
20
I'd like to connect with a therapist who speaks:
*
This field is required.
English
العربية
广东话
Español
Italiano
Ελληνικά
Polskim
Português
ਪੰਜਾਬੀ
Previous
Next
Submit
Press
Enter
21
How would you rank the importance of these therapist qualities in your match?
Drag and drop to order.
Previous
Next
Submit
Press
Enter
22
What's your preferred email?
*
This field is required.
Your personalized therapist matches will be sent via email.
example@example.com
Previous
Next
Submit
Press
Enter
23
When are you looking to start therapy?
*
This field is required.
As soon as possible
In the coming weeks or in a month or so
I’m not sure yet and I'm just exploring my options
Previous
Next
Submit
Press
Enter
24
How would you first like to connect with your therapist matches?
*
This field is required.
Therapists will only contact you via your preferred communication method.
I would like my therapist matches to contact me via email only
I would like my therapist matches to contact me via phone call only
My therapist matches can contact me via email or phone
I want to reach out to my therapist matches on my own terms
Previous
Next
Submit
Press
Enter
25
What's your preferred phone number?
*
This field is required.
Your therapist matches will call you at the number you provide.
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
26
Please let us know if there are any additional precautions we should take when calling you:
*
This field is required.
Calls will always be discreet, but please let us know if there are any additional precautions we should take when contacting you in case we aren't connected with you immediately.
Ok to leave a voicemail or identify self to the person who answers
Do not leave a voicemail
Do not identify as provider to person answering
Previous
Next
Submit
Press
Enter
27
How should we address you? Please feel free to provide your name, an alias, or just your initials.
*
This field is required.
Previous
Next
Submit
Press
Enter
28
What are your preferred pronouns?
*
This field is required.
She/Her
They/Them
He/Him
I prefer being referred to by name
Previous
Next
Submit
Press
Enter
29
What is your age?
If you're filling out this survey on behalf of someone else, please select their age.
Under 18
18-24
25-34
35-44
45-54
55-64
65 or over
Previous
Next
Submit
Press
Enter
30
How did you hear about us?
Google
PsychToday
My Physician or Psychiatrist
Friend, Family, or Colleague
Instagram
LinkedIn
Facebook
Previous
Next
Submit
Press
Enter
31
Who referred you to Clarity Therapy?
If you feel comfortable, please share the name of the person who told you about us.
Previous
Next
Submit
Press
Enter
32
Care to share your feedback with us?
*
This field is required.
Select click "Yes" if you're willing to provide feedback in the coming weeks once you've connected with a therapist.
Yes
No
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
32
See All
Go Back
Submit