H1 Therapy: Let's get started!

H1 Therapy Collective

Human First
Thank you for your interest in H1 Therapy Collective! This brief questionniare will help us match you with the right therapist, address some initial logistics, and give you a chance to ask any questions. As soon as we receive this, we will be in touch with answers to your questions and next steps. We look forward to getting you started!
Your Name:*

First NameLast Name
Email:*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth:*

MonthDayYear
Date
Age:*
Your location (city, state)?*
Services:
What type of services are you seeking?*

Individual therapy for myselfIndividual therapy for my child or adolescentIndividual therapy for multiple family membersCouples' CounselingOther
If you are seeking therapy for someone other than yourself, please provide their full name(s) here:
Is there anything in particular you want or need in a therapist?
Scheduling:
Which office location would work for you? (Please check all that apply)*

Downtown Grand RapidsHudsonvilleSaugatuck/DouglasOnline/Virtual
We strongly recommend beginning therapy at least weekly. Are you able to make that commitment?*

Which time slots would work on a weekly basis? (check ALL that apply)*

How soon are you looking to begin therapy?*
Finances
Our regular fee is $150 per 45-50 minute session. Is that manageable for you out-of-pocket on a weekly basis?*
Regarding insurance, we are out-of-network providers, meaning we do not work directly with any insurance groups. We keep a credit, debit or HSA card on file to be charged at the time of session, and provide a monthly statement you are welcome to submit to your insurance for partial reimbursement. However, we also have some options in place for those in need of financial assistance. Which of the following best describes you?*

I do NOT want to involve my insurance, and will pay $150 out of pocketI can pay the $150, but would like to submit to my insurance for reimbursementI would like to explore other options for financial assistanceI only want to work with a therapist who is in-network so will seek services elsewhere
Aside from any financial assistance (including insurance) how much do you feel you can manage on a weekly basis?*
Other Information
How did you hear about us?*
Is there anything else you feel we should know about you from the start?
Do you have any questions you would like answered at this time?
On a scale of 1-5, how ready do you feel to begin therapy?

1

2

3

4

5

1 is Not ready, 5 is Soooo ready
Should be Empty:

H1 Therapy Collective