Matching Form

1
What areas are you looking to work on in therapy?* This field is required.
Anxiety & Significant Life Changes
Depression and/or Negative Feelings
Trauma or Traumatic Experiences
Relationships with Friends, Family, and Partners
Concerns About Gender or Sexuality
Life in General
Academic/Career Stress or School/Work Transitions
Cultural Identity/Exploration
Other
2
Please tell us about you and what you're hoping to work on in therapy* This field is required.The more details you share, the more personalized recommendations we're able to provide.
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Large
Normal
Small
Ok
Ok
3
Is this your first time seeking therapy?
YESNO
4
Are you interested in a specific type of therapy?(I.e. "I'd like to learn about treatment for anxiety," "I want something more structured that provides homework like CBT," "I'm interested in EMDR")
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Large
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Small
Ok
Ok
5
Would you like your therapist to have expertise in certain areas?
Anxiety
BIPOC and/or Race-Related Concerns
Depression
Entrepreneur & Performance Coaching
Family Issues
Mindfulness
Sex Therapy and/or Sex and Intimacy Concerns
Trauma or Traumatic Experiences
Women's Issues
6
Therapists at our practice are not in-network with any insurance panels. However, if you have out-of-network benefits, your insurance may reimburse you. We'll be happy to check on this for you.Your insurance company typically will reimburse you directly after you've met your deductible.
I know my out-of-network benefits will cover therapy
I don't have out-of-network benefits so will pay out-of-pocket
I want to learn more about my out-of-network benefits
7
Our therapists charge market rate for therapy sessions, with some offering a limited amount of sliding scale. Fees range from $125-$400, depending on the therapist. Please select all of the fee ranges that you're comfortable with.* This field is required.Most PPO insurance plans provide reimbursement for out-of-network services once you meet your deductible. We typically see reimbursements ranging from $50-$250 per session. The actual amount you receive will depend on your plan.
$125-$175
$175-$225
$225-$275
$275-$325
$325+
8
I prefer to meet my therapist:* This field is required.
No Preference
In Person
Virtual/Telehealth
Hybrid
9
What state are you a resident of and/or physically located?* This field is required.Our therapists are licensed in New York State and Florida. Please let us know where you're located so we can make sure to best match you. If not located in one of these states, please speak with your therapist about your location as some states allow out-of-state providers to provide telehealth.
Please Select
Please Select
New York State Resident
Not a New York State Resident but will be physically in NY for sessions
Florida Resident
Not a Florida State Resident but will be physically located in FL for sessions
Other
10
How would you first like to connect with your therapist matches?* This field is required.Therapists will only contact you via your preferred communication method.
My therapist can reach out via email only
My therapist can reach out via phone only
My therapist can reach out via email or phone
I'd like to reach out on my own terms
11
How should we address you? Please feel free to provide your name, an alias, or just your initials* This field is required.
12
What is your age range?* This field is required.
Under 18
18-25
26-35
36-45
46-55
56-65
65+
13
What's your preferred email?* This field is required.Your personalized therapist matches will be sent via email.
14
How did you hear about us?* This field is required.
Google
My Physician, Psychiatrist, or other Med Provider
Clarity Therapy/Clarity Health + Wellness
PsychToday
Friend, Family Member, or Colleague
Other
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