Therapy Interest Form

Therapy Interest Form

For New Clients of My Practice
I am pleased to work with you for marriage, couples, premarital, or family therapy. I specialize in relationship therapy and no longer accept new clients for individual therapy.
* Please Note: Because I am licensed in the state of Maryland, I am only able to see clients who reside in or who are physically located in Maryland at the time when therapy services are rendered.* This includes for telehealth and/or therapy over telehealth platforms. Customers who live in other states travel to work with Dr Knarr for longer sessions including one or two day marathon therapy.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name of spouse, partner, or other family member you are seeking therapy with*
example@example.com
Email of spouse, partner, or other family member you are seeking therapy with*
example@example.com
YesNoMaybe
Fees and Insurance

I do not accept insurance. My fee is $275 per hour for couples/family therapy and $250 for Premarital Therapy. This includes approximately 60 minutes for reviewing your assessments and writing your treatment plan. Please continue this interest form only if you are accepting of the fees. After I complete the treatment plan, I can give you a better idea of how many hours of therapy you will need to resolve your particular concerns.
Marriage/Couples TherapyPremarital TherapyFamily Therapy with Parent(s) and Child/Children
Please Describe What Your Therapy Goals Are....*
YesNo
What Religious/Spiritual Tradition Should Be Included In Your Therapy (If Any)?*
I am a Christian, so I pray for my couples and family privately or with them. Would you like me to pray with you at the start and finish of your therapy appointments?*
How were you referred?*

Therapy Interest Form

Fees and Insurance