Patient's First Name (Not Parent's)
Patient's Last Name (Not Parent's)
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Payment Options (Out-of-Pocket)
Not accepted: BCBS (Couples or Family), EAP, Magellan, Medicare or Medicaid plans
Please include full ID (3 letter prefix for BCBS Insurance)
Please make sure to read visit your preferred therapist profile before selecting an option. Some of our therapists may not be accepting new clients (waitlist only) or may not accept your preferred payment option (insurance)
Suggested Frequency: Please keep in mind we highly suggest a minimum of 6-8 weekly sessions when starting therapy, along with a regular weekly commitment. This will contribute to building a trustful relationship with your therapist and prioritizing your process of healing and growth.
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If not please submit "NA". A member of our support staff will respond in the next 2 business days.