Book a Consultation

Request a Free 10–15 Minute Consultation

We’re glad you’re here. This short form helps us understand what you’re looking for and determine whether we may be a good fit.

You do not need to share anything you’re uncomfortable providing at this stage.
If we determine fit, we’ll reach out within 1 business day to schedule your free consultation.

This form is not monitored 24/7 and is not appropriate for emergencies.
If you are in immediate danger or crisis, please call 911 or go to your nearest emergency room.

Full Name*

First NameLast Name

Preferred Name (if different)

Email*

Confirmation Emailexample@example.com

Phone Number*

Format: (000) 000-0000.

Preferred Contact Method*

State of Residence*

Who is seeking therapy?*

Age of person requesting therapy*

Parent/CaregiverThe client

Important:

If the client is 18 or older, they must complete this form themselves and attend the consultation call personally.
Parent-submitted consultation requests for adult clients cannot be scheduled.

I understand that if the client is 18 or older, they must complete this form and attend the consultation call themselves.

What is bringing you to therapy at this time? *

Please select all time ranges that generally work for you. This helps us match you with the appropriate therapist. Availability does not guarentee a specific appointment time.

Morning (10am-12pm)Afternoon (12pm-2pm)Late afternoon / early evening (3pm-7pm)

Morning (9am-12pm)Afternoon (12pm-2pm)Late afternoon / early evening (3pm-6pm)

Morning (10am-12pm)Afternoon (12pm-2pm)Late afternoon / early evening (3pm-7pm)

Morning (9am-12pm)Afternoon (12pm-2pm)Late afternoon (3pm-5pm)

Final appointment times are confirmed during scheduling in the next step.

Schedule Your Consultation

Your request is not complete until a consultation time is scheduled below.*

You’ll receive a confirmation email and calendar invite once scheduled.

YesNo

Anthem Blue Cross Blue ShieldBlue Shield of CaliforniaOtherUnsure

Insurance details can be reviewed after the consultation if we move forward.

Please check each box to proceed

I understand that submitting this form does not establish a therapy relationship.

I understand that a consultation does not guarantee ongoing treatment.

I understand this form is not monitored 24/7

I consent to being contacted regarding scheduling and next steps