Let's help you find the right therapist

1
What is your name?* This field is required.
First Name
Last Name
2
What is your age?* This field is required.
Please Select
Please Select
18-24
25-28
29-33
34-39
40-49
50+
3
Is this your first time in therapy?* This field is required.
Yes
No
4
What brings you to therapy?* This field is required.
Low Self-Esteem/Confidence
Burnout/Work-Related Stress
Generalized Anxiety
Depression
Health Anxiety
Grief/Loss
Affairs/Betrayal
Relationship Issues
Divorce
Sexual Pain/Sexual Desire
Infertility
Women's Health Issues
Men's Health Issues
Parenthood Stress
Pregnancy
PPD/PPA
Miscarriage/Infertility
Trauma
Cancer
Chronic Illness
Sexuality Exploration
Family Issues
Addiction
OCD
Sexual Abuse
Social Anxiety
Dating Stress
Sexual Esteem
Performance Anxiety
Men's Issues
5
My ideal therapist is:* This field is required.
Solution/Goal-Focused Therapy
Therapy that focuses on my immediate problem
Therapy that explores deeper reasons why I feel the way I do and why I am the way I am
All of the above interest me
6
We value the mental health of our clients and clinicians. While we understand your desire to see a therapist who takes insurance, did you know that often times a practice that takes insurance have therapists seeing approximately 30 people (or more) per week! We find this to be an unrealistic caseload for maintaining the mental health of our clinicians and their ability to be fully invested in you. This is why we are an out of network practice.* This field is required.do you acknowledge that we do NOT take insurance and are OUT OF NETWORK
YESNO
7
The most I am able to spend for out of pocket therapy is:* This field is required.
Please Select
Please Select
$200-250
$250-300
$300+
8
Your preferred mode of therapy:* This field is required.
In-person
Virtual
In-person & virtual
Open to either
9
Are you located in New York or New Jersey?
Please Select
Please Select
New York
New Jersey
Other
10
Email* This field is required.
example@example.com
11
I'm ready to change my life* This field is required.
YESNO
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