Family Virtual Therapy- 60 minute session

Book Appointment Below (Eastern Time Zone)*

Name (Family Member 1)*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Name (Family Member 2)*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Additional Family Members that plan to attend (First, Last Name & Email)

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.*

Please type your state's initials

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 sfarquharson@faithworkstherapy.com*

I consent to receive communication by email

1 hr Family Virtual Session

60 minute Session

You will receive a separate email containing the HIPAA-compliant Google Meet link.

$100.00

Total

$0.00

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.