Rise Psychology NYC - Matching Questionnaire

1
What kind of therapy or services are you interested in?** This field is required.
Individual Therapy
Family Therapy for Children (Adolescents and Teens)
Group Therapy or Support Groups
Meditation and Wellness Workshops
2
What areas would you like to work on in therapy?* This field is required.
Academic/Career Stress or School/Work Transitions
Anxiety & Significant Life Changes
Concerns About Gender or Sexuality
Concerns About Health
Concerns About Race or Social Injustice
Cultural Identity/Exploration
Depression and/or Negative Feelings
Life in General
Relationships with Friends, Family, and Partners
Sex and Intimacy Concerns
Trauma or Traumatic Experiences
3
Please tell us about you and what you'd like to work on in therapy.* This field is required.The more you share, the more personalized recommendations we're able to provide.
4
What kind of therapist would feel like a good fit for you?* This field is required.Example: 'I want a therapist who…' / 'I don’t want a therapist who…'
Your input helps us match you with a therapist who fits your needs.
5
Do you have any preferences regarding the identity or background of your therapist?* This field is required.If you have no specific preferences, choose 'No preference'.
No preference
Male
Female
Non-Binary
Transgender
BIPOC (Black, Indigenous, and People of Color)
LGBTQIA+
Multilingual therapist - العربية (Arabic), 粵語療法 (Cantonese), Español (Spanish)
6
Is this your first time seeking therapy?* This field is required.
Yes, I'm new to therapy
No, I've been in therapy before
7
Therapists at our practice are not currently in-network with insurance companies. However, if you have out-of-network (OON) benefits, your insurance may reimburse you for part of the cost with eligible providers.* This field is required.Clients typically receive reimbursements between $50–$250+ per session, depending on their plan.
I’d like to pay out of pocket
I know that my out-of-network benefits will cover therapy
I’d like to learn more about using my out-of-network benefits
I’d prefer low-fee services with a therapist-in-training
I’m open to working with a pre-licensed therapist at a reduced rate
I’m looking to work with a fully licensed therapist
8
Considering potential insurance reimbursement, how flexible is your budget?* This field is required.The average fee for a 45-minute session in NYC is $275/session.
Flexible for an ideal match
Able to afford the upper range comfortably
Fixed budget, unable to adjust
9
What type of session format works best for you? Your answer will help us match you with a therapist whose availability aligns with your preferences.* This field is required.Please note: Therapists must be licensed in the state where the client is located to offer virtual therapy. Our team can provide:
I prefer in-person sessions in our midtown office in NYC
I prefer virtual/telehealth sessions from my location in NY or NJ
I prefer a mix of in-person and virtual sessions
I’m open to any session format
10
Which times work best for therapy sessions?* This field is required.
Anytime between 9am-5pm on weekdays
Before 9am on weekdays
After 5pm on weekdays
Weekends
I’m flexible
11
When are you looking to start therapy?* This field is required.
As soon as possible
In the coming weeks or in a month or so
I’m not sure yet and I'm just exploring my options
12
What's your preferred email? * This field is required.
Your personalized therapist matches will be sent via email.
13
What's your preferred phone number?* This field is required.
You will only be contacted by phone if you give us permission.
14
What’s your preferred way to be contacted by potential therapist matches? Therapists will only reach out using the method you choose.* This field is required.
I would like my therapist matches to contact me via email only
I would like my therapist matches to contact me via phone call only
My therapist matches can contact me via email or phone
I want to reach out to my therapist matches on my own terms
15
How should we address you? * This field is required.Please feel free to provide your name, an alias, or just your initials.
16
What are your pronouns?* This field is required.
She/Her
They/Them
He/Him
I prefer being referred to by name
17
What is your age?* This field is required.If you're filling out this survey on behalf of someone else, please select their age.
Under 18
18-24
25-34
35-44
45-54
55-64
65 or over
18
How did you hear about us?* This field is required.
Google
Psychology Today
My Physician or Psychiatrist
Friend, Family, or Colleague
A current or former Rise client
Instagram
LinkedIn
X (formerly Twitter)
Facebook
Other
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