WELCOME!

Thank you for your interest in Couch Therapy. I understand how sacred the therapist-client relationship is and feel privileged to be considered as a companion on your journey.

My aim is to create a welcoming, non-judgmental space where you can feel supported—recognizing that you're doing your best with the resources you have. Your well-being is always my top priority, and I am committed to addressing your individual needs.

Finding a therapist with whom you feel comfortable and supported is crucial. Research underscores the significance of the therapeutic bond between client and therapist as a key factor in successful treatment outcomes. This form assists me in determining whether my approaches align to best serve your needs.

You can expect to receive an email from us within two business days of submitting this form.

Potential Client Name*

First NameLast Name

Name and Relationship of Person Completing Form (if different than client)

Client Preferred Name*

Client Pronouns*

Client Date of Birth*

Date

Client Age*

City and State of Residence*

Sarah is licensed to practice psychotherapy for residents in the state of South Carolina.

Please note that we exclusively offer teletherapy services and do not provide in-office appointments. Are you comfortable with this arrangement? *

Why are you currently seeking therapy? What are your goals for therapy?*

Have you had any previous experiences with therapy? If so, were there any particular things that you found helpful or unhelpful?*

Do you have any other questions or information that you wish to share?

What is your availability for sessions?*

How did you learn about Couch Therapy?

Health Insurance Policy

At Couch Therapy, we do not accept health insurance.

We've discovered that our treatment approach may not always align with insurance company requirements. When therapists accept insurance payments, they are obligated to provide a diagnosis and ongoing documentation of treatment to demonstrate medical necessity, which often involves disclosing private information. We value your privacy and believe your treatment should remain confidential between you and your therapist. Moreover, insurance policy benefits frequently change, sometimes unexpectedly, which could impact your therapy at critical junctures. By assuming financial responsibility for your treatment, you retain full control over your services. Please note that we are unable to furnish superbills for potential reimbursement from your insurance provider.

Please see the fee schedule below for current fees.

Contact Information

Phone Number*

Please enter a valid phone number.

Do you consent to receive text messages from Couch Therapy?*

Yes, I consent to receiving text messages.No, I do not consent to receiving text messages.

Do you consent to receive phone calls and voicemails from Couch Therapy?*

Yes, I consent to receiving phone calls and voicemails.Yes, I consent to receiving phone calls, but do not leave voicemails.No, I do not consent to phone calls.

Email*

example@example.com

Do you consent to receive emails from Couch Therapy?*

Yes, I consent to receiving emails.No, I do not consent to receiving emails.

Contact through this form should not be used for emergency situations. If you believe you or another individual is suffering a mental health crisis or other medical emergency, contact your doctor immediately, seek medical attention immediately in an emergency room, or call 911.*

I attest that I am not using this form for an emergency situation.