Interested in working together?
Tell me a little about yourself, and we’ll reach out as soon as possible!
Name
*
First Name
Last Name
Email
*
example@example.com
Are you in need of sliding scale? Please note that Asher does not currently take insurance.
*
Yes
No
What conditions are you looking to manage with therapy?
*
Please include things you have been officially diagnosed with and things you may have not been officially diagnosed with.
What is your previous experience with therapy, if any? (If you do not have prior experience, put N/A)
What are you looking for a in a therapist?
*
IE: type of therapeutic approach, specific therapeutic needs and concerns.
Type(s) of therapy I am interested in:
*
Individual psychotherapy
Group psychotherapy
Family therapy
Couples therapy
Are you struggling with any of the following conditions:
*
Eating disorders
Complex trauma
ADHD
Body image distress
Gender Dysphoria
Compulsive Behaviors
Do you reside in New York, Michigan, or Wisconsin and/or have access to a permanent address in one of these states? If you answered “no,” please let us know where you are located in the following survey item.
*
Yes
No
Is there anything else we should know? If you answered “No,” to the above question, please let us know where you are located in this text box.
*
Are you only interested in seeking a consultation for therapeutic services with Asher, or are you open to other therapists at Asher and Lauren’s practice, Affirmative Therapy Collective (ATC)?
*
Interested in Asher only
Interested in any therapist at ATC
How did you find me?
*
Submit
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