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  • *Appointment Request Form

    This quick form helps me get to know you — what you’re looking for in therapy, your availability, and how you’d like to handle payment or insurance. It’s designed to make your first session feel smooth, personal, and totally aligned with what you need. Once I’ve reviewed your form and it feels like a good therapeutic fit, I’ll personally send your Welcome Message — your simple roadmap for getting started. Inside, you’ll find:​📅 Your Intake Appointment Date & Time✅ Your Benefits Quote / Good Faith Estimate📝 Quick Digital Intake Forms & Assessments🔗 Your Instant Virtual Waiting Room Link — just tap when it’s time. No downloads. No tech stress.To officially lock in your spot, just reply “C” to your Welcome Message — and we’ll make it happen! 💫 Melissa E. Mendoza, LMSW / Pink Psy Counseling
  • 🩷1 OF 2 CLIENT PROFILE

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  • Tell me a little about what’s been happening that made you decide it’s time for therapy.(This helps me understand your story and what kind of support you’re looking for.)

  • Contact Information

  • 🗓️ Scheduling Preferences

    Select your availability for Intake Appointment: (Check all that apply)
  • 💳 2 of 2 HEALTH INSURANCE DETAILS

    I collect this information to verify your benefits so you have clarity before starting.All uploads are encrypted and HIPAA-secure.
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  • 🩷 Final Step — Sign Below and I'll Take it From Here

    🩷 Final Step — Sign Below and I'll Take it From Here

    Once I review your form, and if it feels like a good therapeutic fit, I’ll personally send your Welcome Message with your appointment details and next steps. — Melissa
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