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
Pregnancy/Postpartum Concerns
Other
2
In Depth or Quick Questionnaire?* This field is required.The more information we have, the better to match you. But we also understand if you're in a rush (or just hate detailed questionnaires!). Are you up to give us some more in depth information or just looking for a quick match?
I want to give more in depth answers
Give me the quick version
3
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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4
Please describe the key qualities or traits you'd like your therapist to have.Feel free to include anything you'd like to avoid as well. E.g.: "I want a therapist who... I don't want a therapist who..."
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5
Is this your first time seeking therapy?
YESNO
6
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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7
Would you like your therapist to have expertise in certain areas?
Anxiety
BIPOC and/or Race-Related Concerns
Depression
Entrepreneur & Performance Coaching
Executives, Finance, or Consulting
Family Issues
Grief & Loss
LGBTIA+
Men's Issues
Mindfulness/Meditation
Sex Therapy and/or Sex and Intimacy Concerns
Trauma or Traumatic Experiences
Women's Issues
Young Adults
8
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.* This field is required.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
9
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+
10
Which session format works best for you?* This field is required.Therapists must be licensed in the state where the client is located for virtual sessions.
I prefer in person sessions in NYC.
I prefer virtual telehealth sessions from home.
I prefer a mix of both in person and telehealth session (hybrid).
I'm flexible.
11
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
New Jersey Resident
Florida Resident
I'll be physically present for sessions in either NY, NJ, or FL
Other
12
Which times work best for therapy sessions?* This field is required.Please select all that apply.
Anytime between 9-5 weekdays
Before 9am weekdays
After 5pm weekdays
Weekends
I'm flexible
13
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
14
How should we address you? Please feel free to provide your name, an alias, or just your initials* This field is required.
15
What are your pronouns?
She/Her
He/Him
They/Them
Choose to be referred to by name
Other
16
What is your age range?* This field is required.
Under 18
18-25
26-35
36-45
46-55
56-65
65+
17
When are you looking to start therapy?
As soon as possible
In the next few weeks
I'm not sure yet and just checking out my options
18
What's your preferred email?* This field is required.Your personalized therapist matches will be sent via email.
19
What Is your phone number?
Area Code
Phone Number
20
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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