Request for Therapy with Dr. Alexandra Solomon
Please provide some basic information to help us determine if Dr. Solomon is the right fit.
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Partner's Name
First Name
Last Name
Partner's E-mail
example@example.com
What is your availability for appointments? Dr. Solomon primarily schedules during the day on weekdays.
I understand that Dr. Solomon does not submit to or take insurance. She is able to provide a superbill for you to submit to your insurance for reimbursement.
I understand
How would you like to see Dr. Solomon? At this time, she is not seeing any patients fully in person.
Please Select
Fully remote
A blend of remote and in person
Fully in person
What are you hoping to work on with Dr. Solomon?
Is there anything else you would like to share?
Submit
Should be Empty: