Savvy Intuition, LLC Consultation form

Savvy Intuition, LLC

Consultation Form
This form helps us get a clear picture of your needs, goals, and current situation so we can determine the best next step for working together. Whether you’re seeking therapy, coaching or a couples intensive, the more detail you can provide, the better we can tailor our recommendations.

Please complete all questions as openly as you feel comfortable.
🕒 Estimated time to complete: 5–10 minutes
🔒 Your responses are confidential.

Frequently Asked Questions
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number. An account in the client portal cannot be created without this information.
Email*
An account in the client portal cannot be created without this information.
Date of Birth (therapy consultation only)*

MonthDayYear
An account in the client portal cannot be created without this information.
What is your profession?
How did you hear about Savvy Intuition, LLC and/or who were you referred by?*
Are you currently in therapy?*

YesNoOther
What type of counseling/therapy are you seeking? (Please note: insurance does not cover couples counseling/therapy, intensives, Emotional Support Animal Services at all.*

Pre-Marital CounselingEmotional Support Animal ServicesCouples CounselingFamily CounselingIndividual Mental Health TherapyDiagnostic Assessment onlyCouples IntensiveCoachingFamily Intensive
If Couples Counseling, provide your partner's name (Couples are required to complete consultation forms individually not together.)

First NameLast Name
What is you main struggle/concern?*
Have you had any therapy/counseling in the past? Was it beneficial?*
On a scale of 1 to 7 how ready are you to start therapy and commit to doing the work?*
Please select the type of sessions you would prefer:*

VirtualIn-Personboth
I have read and understand the Frequently Asked Questions (FAQ) on the website for services.*

YesNo
I understand that insurance requires a mental health diagnosis and does not cover traditional couples therapy or traditional family therapy.*

YesI'm not seeking traditional couples therapy or traditional family therapy.
I understand that depending on the type of family therapy that I am seeking, that I may have to pay out of pocket.*

YesI'm not seeking family therapy
I understand that couples counseling, ESA letters and intensives are not covered by insurance.*

YesI'm not seeking couples counseling, an ESA letter or intensives.
Identify your payment method:*

Aetna (couples therapy not covered)Afterpay (acceptable for traditional couples/family therapy, packages & intensives)Anthem/BlueCross BlueShield (couples therapy not covered)CareCredit (acceptable for traditional couples/family therapy, packages & intensives)CareSource (couples therapy not covered)HSA/FSAMolina (couples therapy not covered)***OpenPath Psychotherapy CollectiveSelf-payUnitedHealthcare/Optum/UMR/Oscar (couples therapy not covered)
Are you interested in learning more about adjusted fee rates?
Your availability for appointments (please provide timeframes that work for you)*
List your questions here.
Please note: Frequently Asked Questions can be found on the website - www.savvyintuitionllc.com.
Please verify that you are human*
Should be Empty: