Name
First Name
Last Name
Age
Phone Number
Email
example@example.com
Reasons for Seeking Therapy
Do you have a preference for Day of Week and Time of Day, or would you like a first available appointment?
How frequently do you prefer to meet?
Weekly
Every 2-3 Weeks
Monthly
Every 6-8 Weeks
Quarterly
I prefer to meet:
In Person: Tuscaloosa
Telehealth
Our rates are $150/Assessment and $130/55 minute session. Deanna is currently private pay only and offers sliding scale payment options. Please select your preferred method of payment.
I plan to private pay
I would like to discuss sliding scale options
If you plan to use insurance, what kind of insurance do you have?
Do you have any questions before we schedule?
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