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Contact Form

Contact Form

This quick and simple form will expedite the first step of your scheduling experience and help us match you with your best therapist. All of your answers are confidential and protected by HIPAA medical standards.

HIPAA

Compliance

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    (You must at least fill in either a phone number or email in the sections below for us to be able to reply to your request)
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    Please be aware confidential messages may be sent to the email address you provide.
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    Please be aware confidential voicemails/texts may be sent to the phone number you provide.
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    If you are unsure, we can still help you find your best match no matter what you select.
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    If you select yes, you may choose more than one therapist on the next page. If you select no, we will help match you with your best therapist using additional information you provide to us.
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    Please note: Certain clinicians may not be able to accept new clients dependent on their current caseload and may not have office times during your preferred days/times.
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    Please note: Certain clinicians may not be able to accept new clients dependent on their current caseload and may not have office times during your preferred days/times.
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    Please note: Certain clinicians may not be able to accept new clients dependent on their current caseload and may not have office times during your preferred days/times.
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    Just a reminder, your answers are confidential and strictly protected by HIPAA standards. We will not share any of your information without your consent.
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    It's ok to simplify your answer, most situations are much more complex than this text box allows. (This form is intended only as an initial contact form. An intake form will be sent once an appointment is made so you will be able to include further details).
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    * Reimbursement rates are dependent on your insurance plan guidelines. Any student intern rate, which is a reduced rate, is not reimbursable by insurance.
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    Late Cancellation and No Show Policy:  A fee of $70 will be charged for any session canceled with less than 24 hour notice. For any sessions that are a no show with no communication, the fee assessed will be for the full session rate of $145.

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    Tenga en cuenta que es posible que se envíen mensajes confidenciales a la dirección de correo electrónico que proporcione.
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    Tenga en cuenta que es posible que se envíen mensajes de texto/correos de voz confidenciales al número de teléfono que proporcione.
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    * Las tasas de reembolso dependen de las pautas de su plan de seguro.
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    Tus pensamientos...
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