Getting Started

Getting Started
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date Of Birth*

MonthDayYear
Date
We will only accept Blue Cross Insurance after 6/16/23.

Please visit the payment page on our website for our rates. Most plans will offer out of network 60-80% reimbursement. Call your insurance company to find out what your plan covers.
Insurance Name*
Insurance Group Number*
Please Upload Images Of Your Insurance Card (Front and Back)*

Browse Files

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Primary Insured's Name*

First NameLast Name
Primary Insured Date of Birth*

MonthDayYear
Date
Preferred Therapist *
What Service Or Services Are You Looking For?*

Individual TherapyCouples TherapyIntensive Couples TherapyMen's Compulsive Behavior GroupsBetrayal Trauma Partner GroupPelvic Pain GroupADHD Men's GroupPartner of ADHD Individual Group
How can we help you? Please be specific so we can match you with the best clinician *
Preferred Time For Sessions*
Please Verify That You Are Human*
Should be Empty:

We will only accept Blue Cross Insurance after 6/16/23.