Getting to know you

1
Name
First Name
Last Name
2
What is your gender?
Female
Male
Non-binary/Third Gender
Prefer to self describe
Prefer not to say
3
Email
example@example.com
4
Phone Number
Area Code
Phone Number
5
What kind of support are you seeking at this time?Check all that apply
Individual Psychotherapy
Relationships or couples counseling
Group therapy
Trauma-focused work
Psychedelic assisted therapy
6
How are you planning to pay for sessions?Check all that apply
BCBC (in network)
Self-pay
I plan to use super bills for out of network reimbursement
I am interested in sliding scale options (if available)
Other insurances
I am still exploring what works best for me at this time
7

At this time, Soul Warrior Psychotherapy is only in-network with Blue Cross Blue Shield.
If you selected “Other Insurance” in the previous question, your options are below:

- Explore self-pay, sliding scale, or superbill options.
- Review a complimentary list of trusted referral providers I have put together for you here:[Referrals- trusted providers].

Should you choose to pursue a path elsewhere, know that my goal is to support you and guide you as best I can on your healing journey.
If you wish to explore your other options further with me, feel free to move forward with the form.
Whatever you choose, I wish you peace and support on your healing path.
8
In a few words, please describe what brings you here today and what feels like the main area you would like support with right now?
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9
What are some of the goals that you wish to achieve in therapy?
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10
Are you looking for in person or virtual sessions?
In person
Virtual
11
Is there anything else you would like me to know about you?
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