Mandarin Therapy Request

框架合作伙伴 (Framework Associates)

寻求一位能说普通话的治疗师 (Requesting a therapist who speaks Mandarin)
姓名 (Name)*

Nombre de pilaApellido
电子邮件 (Email)*
example@example.com
电话号码 (Phone #)*
患者生日 (Date of Birth)*
患者生日 (Which Service)*

个体治疗 (Individual Therapy)夫妻疗法 (Couples Therapy)
您更喜欢哪种付款方式？(How would you prefer to pay?)*

使用信用卡支付 $175 (Pay with a credit card. $175)我想使用我的保险 (Use insurance.)
如果您想使用您的保险，请上传您的保险卡照片 (If you want to use insurance, please upload your insurance card)

Cancelof
我们将在 1 天内给您发送电子邮件 (We will email you in 1 business day.)

我们将在研究您的保险后通过电子邮件向您发送报价 (We will research your insurance benefits and email you a quote.)

我们将通过电子邮件向您发送 Erica Chi 博士的在线日历链接。点击邮件中的链接即可在她的日历上安排会面 (We will email you a link to Dr. Chi's online calendar. You can self-schedule at your convenience.)
Should be Empty:

框架合作伙伴 (Framework Associates)