Couple Virtual Therapy
60 minute Session
Book Appointment Below (Eastern Time Zone)
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Name (Partner 1)
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First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Name (Partner 2)
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First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Location Confirmation: Sessions can only be booked with clients in the following states: (PA), (NJ), (DE), (TX), (NV), (AZ), (OR), (GA). I understand that my clinician can only provide telehealth services while I am physically present in the state where they hold a professional license. I agree to ensure my location complies with this requirement for every session.
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Please type your state's initials
Cancellation Policy: By checking the box below, I agree that I understand the cancellation notice is 24 hours in advance. No refunds available after 24 hours and/or for paid but missed/forgotten sessions.
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I agree
Email Communication Consent : I understand that while FaithWorks Therapy uses HIPPA-Compliant forms, standard email is not encrypted. Appointment reminders will be sent directly to the email address provided above. I authorize FaithWorks Therapy to send non-urgent information by email, including: Appointment reminders and scheduling, billing or insurance information and general administrative updates. I may withdraw this consent at any time by notifying FaithWorks Therapy via email faithworkstherapy4u@gmail.com
I consent to receive communication by email
Couples Virtual Therapy (Select Checkbox)
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60 minute Session
You will receive a separate email containing the HIPAA-Compliant Google Meet link.
$
100.00
Need help sooner? To request an earlier available slot or emergency same-day session, use space below to type preferred dates & times. If slots are open, you will be rescheduled to the new preferred slot. A confirmation email will be sent.
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