PreScreener Form
Thank you for your interest in A Will to Thrive Counseling. This brief prescreener helps determine whether Dr. Walker's practice may be a good fit for your needs at this time. Please answer all questions honestly — there are no wrong answers. If eligible, you will receive a link to schedule a free 15-minute consultation.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you 18 years of age or older?
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Yes
No
Are you currently located in North Carolina and will you be physically in North Carolina for all sessions?
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Yes
No
Dr. Walker's availability is Monday through Thursday, 8:00 AM – 2:00 PM. Are you able to attend sessions during these hours?
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Yes
No
Possibly — I'd like to discuss
Are you currently experiencing a crisis or in need of a higher level of care than weekly outpatient therapy?
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Yes
No
Possibly — I'd like to discuss
Dr. Walker accepts the following insurance plans: Blue Cross Blue Shield, Aetna, Anthem, Cigna, Optum, and United Healthcare. Do you have one of these plans or will you be using self-pay?
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Yes, I have one of Dr. Walker's accepted insurance plans
I will be self-pay
Possibly — I'd like to discuss
Dr. Walker's self-pay rates are $150 for a 45-minute session and $200 for a 60-minute session. Couples therapy is self-pay only. Are you comfortable with these rates?
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Yes, I am comfortable with these rates
No, these rates do not work for me
Not applicable — I have insurance
What is bringing you to therapy at this time?
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What are you hoping to gain from therapy or this service?
Is there anything else you would like Dr. Walker to know before your consultation?Optional
By submitting this form I understand that completing this prescreener does not guarantee services and that the consultation is intended to explore fit and next steps.
*
I understand and agree
Submit
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