Contact Rebecca
Hello! Thank you for reaching out. Please fill out this form to help me better understand your needs and see if our availability matches.
Email
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example@example.com
Chosen Name
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First Name
Last Name
Pronouns
Phone Number
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Why are you seeking support at this time?
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If you are coming for relationship support, what is the name and email of your partner(s)?
At this time, I am not in-network with any insurance companies. I work with self-pay clients and individuals who use out-of-network benefits. I can provide you with a superbill if you would like to utilize out-of-network benefits. Please indicate which option best suits your needs:
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I will be a Self-Pay client
I will be utilizing Out-of-Network Benefits
Fee Structure (please choose the option that best suits your needs):
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Individual Psychotherapy Community Support Session Fee - $400
Individual Psychotherapy Community Support Session Fee - $350
Individual Psychotherapy Full Session Fee - $300
Individual Psychotherapy Full Session Fee - $250
Individual Psychotherapy Sliding Scale Session Fee - $200
Individual Psychotherapy Sliding Scale Session Fee - $150
Relationship Therapy Community Support Session Fee - $500
Relationship Therapy Community Support Session Fee - $450
Relationship Therapy Full Session Fee - $400
Relationship Therapy Full Session Fee - $350
Relationship Therapy Sliding Scale Session Fee - $300
Relationship Therapy Sliding Scale Session Fee - $250
I need additional Sliding Scale Options (Your budget does not offend me, please select this option if you need it).
I will be using insurance benefits
What days/times over the next 2 weeks are you available for a short 15-minute consultation call?
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What ongoing days/times would you be available for session times?
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In the event that I do not have any spaces available, are you open to being added to a waitlist.
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Yes, please add me to the waitlist.
No, please do not add me to the waitlist.
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