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
We Only Accept Blue Cross Plans
Please visit the payment page on our website to review our rates. Many plans will offer out of network coverage with 60-80% reimbursement. Call your insurance company to find out what your plan covers. No Medicare or Mass Health products.
Insurance Name
*
Insurance Group Number
*
Please Upload Images Of Your Insurance Card (Front and Back)
*
Browse Files
Cancel
of
Primary Insured's Name
*
First Name
Last Name
Primary Insured Date of Birth
*
-
Month
-
Day
Year
Date
Preferred Therapist
*
Michele Waldron
Susan Ott
Terry Burch
No Preference
What Service Or Services Are You Looking For?
*
Individual Therapy
Couples Therapy
Men's Compulsive Behavior Groups
Pelvic Pain Support Group (monthly)
18-week Cultivating Sexual Desire Group
ADHD Men's Group
Woman's Sexuality Group
* Couples Desire Discrepancy Workshop (group)
*Couples Desire Discrepancy Intensive (one couple)
*Creating a Sexual Menu for Couples Workshop (group)
*Creating a Sexual Menu Couples Intensive Therapy (one couple)
4-week Erectile Dysfunction Group
18-week Pelvic Pain Group
Services with a (*) next to them are not covered by insurance
How did you hear about us?
*
AASECT Website
Psychology Today Website
Social Media
Therapist
Medical Provider
Radio Station
Other
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
*
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