New Appointments

Information submitted through this form is encrypted and confidential. We need to collect this information in order to verify your insurance so that your appointment can be seamless when you arrive.

Legal Name (as registered with your insurance company) *

First Name Last Name

Preferred Name

First Name Last Name

DOB *

Gender

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

E-mail *

Known Mental Health Diagnosis

Are you seeking medication evaluation from us? We do not conduct medication evaluations. Please contact your insurance company for a referral. *

No

Primary Reason for Appointment *

Name of Guardian Completing Form if Applicable

Please read these instructions carefully and completely.

Below are the therapists who are currently accepting new patients. Please select the one you'd like to see and we will contact you to make an appointment with that therapist. You may select more than one.

Click here to view each therapists' profiles.

Athena Weggler, LMHC

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Mondays 10:00 - 4:00pm

Tuesdays: 10:00 - 4:00pm

Wednesdays: 10:00 - 4:00pm

Thursdays: 10:00 - 4:00pm

Athena Weggler accepts the following insurances

Boston

Dan Halloran, LICSW

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Mondays 10:00 - 4:00pm

Tuesdays: 10:00 - 4:00pm

Wednesdays: 10:00 - 4:00pm

Thursdays: 10:00 - 4:00pm

Fridays: 10:00 - 4:00pm (alternating)

Saturdays: 9:00 - 5:00pm (alternating)

Dan Halloran accepts the following insurances

Boston

Constance Lum, LICSW

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TELETHERAPY ONLY

Thursdays: 9:15 - 5:00pm

Constance Lum accepts the following insurances

Boston

Brendan Clarke, LMHC

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Currently not taking new patients.

Brendan Clarke accepts the following insurances

Boston

Taylor Lombard, LMHC

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Currently not taking new patients.

Taylor Lombard accepts the following insurances

Boston

Tyler Twombly, LMHC

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Currently not taking new patients.

Tyler Twombly accepts the following insurances

Boston

Marjorie Thomsen, LICSW

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Currently not accepting new patients.

Marjorie Thomsen accepts the following insurances

Boston

Kate Schiffman, LMHC

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Currently not accepting new patients.

Kate Schiffman accepts the following insurances

Boston

Cassandra Xanthos, LICSW

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Currently not accepting new patients.

Cassandra Xanthos accepts the following insurances

Boston

Barbara Hershey, LICSW

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Currently not accepting patients.

Barbara Hershey accepts the following insurances

Boston

Emily Eldar, LMHC

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Currently not taking new patients.

Emily Eldar accepts the following insurances

Boston

Ana dos Santos, LMHC

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Currently not taking new patients.

Ana Santos accepts the following insurances

Boston

Card Holder's Name or "N/A" for private pay. *

Please upload a photo of the front of your insurance card.

Please give us some dates and times that you are available. *

If you are a referring provider, please give us your name and contact information. If you are not, please enter "N/A". *

We're considering adding teletherapy to our services (therapy via video conference). Is this something you would be interested in? *

Yes No Yes, only if there's no availability for face-to-face

Please let us know if there is anything else you'd like to share with us (disability accommodation, language needs, etc.).

You may securely upload any pertinent patient information.

How do you prefer us to contact you? *