Booking at Emotions In Harmony

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Have you had an appointment with us before?* This field is required.

No, this is my first time scheduling

Yes, I have already registered

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Type of Service* This field is required.Our prices are in US Dollars

Individual Therapy = $280

Couples Therapy = $297

Family Therapy = $297

Immigration Evaluation = $2,325

Life Coaching = $117

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Legal Name* This field is required.

First Name

Last Name

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Chosen Name* This field is required.

First Name

Last Name

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Gender* This field is required.Example: Man / Non-Binary / Transgender / Woman / Other

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Date of Birth* This field is required.

Date

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Phone Number* This field is required.

Area Code

Phone Number

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E-mail* This field is required.

example@example.com

Confirm Email

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Without including yourself, how many adults members will attend therapy?* This field is required.

1 Member

2 Members

3 Members

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Your Partner's Legal Name* This field is required.

First Name

Last Name

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Your Partner's Chosen Name* This field is required.

First Name

Last Name

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Your Partner's GenderExample: Man / Non-Binary / Transgender / Woman / Other

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Your Partner's Date of Birth* This field is required.

Date

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Your Partner's Phone Number* This field is required.

Area Code

Phone Number

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Your Partner's Email* This field is required.

example@example.com

Confirm Email

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Your Family Member's Chosen Name (1)* This field is required.

First Name

Last Name

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Your Family Member's Phone Number (1)* This field is required.

Area Code

Phone Number

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Your Family Member's Email (1)* This field is required.

example@example.com

Confirm Email

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Your Family Member's Chosen Name (2)* This field is required.

First Name

Last Name

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Your Family Member's Phone Number (2)

Area Code

Phone Number

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Your Family Member's Email (2)

example@example.com

Confirm Email

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Your Family Member's Chosen Name (3)* This field is required.

First Name

Last Name

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Your Family Member's Phone Number (3)

Area Code

Phone Number

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Your Family Member's Email (3)

example@example.com

Confirm Email

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Do you live in California (USA) or in Mexico?* This field is required.Click "NO" if you belong to a country other than the mentioned before.

YesNo, I live in another country

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Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Alternative AddressFill this out in case your partner lives at a different address than the stated before.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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How did you hear about us?* This field is required.

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Could you please elaborate on where did you find us?* This field is required.

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Do you want to book the appointment by yourself?* This field is required.

Yes

No, please contact me

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In which language would you like to have your session?* This field is required.

English

Spanish

Both are fine for me

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Therapy Modality* This field is required.

In Person

Online

Both are fine for me

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Your psychologist is ready to meet with you!* This field is required.

Dr. Carmen Román

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Which psychologist do you prefer? Both are ready to meet with you!* This field is required.

Dr. Liz Caine

Dr. Carmen Román

Please assign me one

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NO BORRAR, USAR EN CASO DE UN NUEVO PSICÓLOGO... Which psychologist do you prefer? They are both fully bilingual!* This field is required.

Dr. Carmen Román

Ana Valle, LMFT

Please assign me one

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Coaching services are available in SPANISH ONLY for now.
Sessions are virtual via Zoom.

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Choice of Payment* This field is required.If you pay for the 12 sessions upfront, you will receive a discount, saving $120.

Individual (per session) = $117

Total Payment (12 sessions for $107) = $1,284

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Our coach is ready to work with you!* This field is required.

Rosa Estela Mendoza M.S.

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Do you want to subscribe to our Newsletter?* This field is required.If you subscribe, you will receive our free content

Yes, I want to receive the content for free!

No, I'll subscribe later

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