Getting Started
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender Identity
Please Select
Male
Female
Nonbinary
Other
Preferred Therapist
*
Michele Waldron
Susan Ott
Terry Burch
No Preference
What Service Or Services Are You Looking For?
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Individual Therapy
Ongoing Couples Therapy
3-6 hour couples intensive weekend/evening virtual/in person Bedford, MA *not covered by insurance (virtual session is $250/hr, in-person session is $275/hr)
Men's Compulsive Behavior Groups
Emotion Regulation Group (all genders)
18-week Pelvic Pain Group
Betrayed Partner Support Group
*Couples Desire Discrepancy Intensive therapy* not covered by insurance (minimum 3 hrs - virtual $250/hr, in-person $275/hr)
*Creating a Sexual Menu Couples Intensive Therapy (one couple)* not covered by insurance (minimum 3 hrs - virtual $250/hr, in-person $275/hr)
How did you hear about us?
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AASECT Website
Psychology Today Website
Social Media
Therapist
Medical Provider
Radio Station
Gottman Directory
Perinatal Mental Health (PSI) Directory
Other
How can we help you? Please be specific so we can match you with the best clinician
*
I understand that we do not accept or bill insurance. Please see our payment page for rates and questions to ask your insurance about out of network coverage.
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Please Select
Yes
No
Preferred Time For Sessions
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Please Verify That You Are Human
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