• Tell us about yourself

    Share your details and what you need help with. We will contact you to schedule.
  • Format: (000) 000-0000.
  • Best way to reach you
  • Do you have a preferred therapist?
  • Do you have a prescription or referral from a provider? (If you do, you can upload it after you send this.)

  • Fees and insurance

    Before we schedule, here is how payment works. New patient evaluation: $300. Follow-up visits: $150 (30 min) or $225 (45 min). We are out-of-network with commercial insurance plans and we can provide a superbill upon request, including for HSA and FSA accounts. We are a non-participating Medicare provider: with Original Medicare we submit your claims for you, and you are responsible for the 20% Medicare does not cover. Medicare Advantage plans are handled like other insurance, with a superbill. Cancellations need 24 hours notice; late cancellations are $75.
  • Which best describes your coverage?*
  • Do you understand our fees and insurance policies?*
  • How would you like to continue?*

  • A few details

    This helps us get ready for your first visit. It takes about 3 minutes.
  • Date of birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Take a photo or choose a file
    Drag and drop files here
    Choose a file
    Cancelof

  • Your insurance

    Upload a photo of your insurance card. That is all we need to get started.
  • Take a photo or choose a file
    Drag and drop files here
    Choose a file
    Cancelof
  • Are you the primary card holder?
  • Card holder's date of birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have secondary insurance?
  • Take a photo or choose a file
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: