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Who is seeking services?
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Individual Counseling (adolescent 10-23)
Individual Counseling (adult 24+)
Brain Spotting Only
Team Building/Mental Check in
What state do you currently reside?
How do you plan to pay for services
BCBS (Optum Behavioral Health)
Medicare (Please check if a referral if needed).
Other (Please state type of Insurance)
Fall and Winter consultations are completed on Friday Mornings.
What are your intentions for therapy?
Should be Empty: