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Thank you for your interest in beginning your healing journey. To get started, please complete the secure contact form below. Once we receive your information, we’ll reach out to schedule an initial appointment and discuss what you’re looking for support with, your availability, and next steps.

Therapy Interest Form

  1. Contact Info.

  1. Location

Are you physically located in that state for sessions?
Yes
No
Time zone

  1. What brings you in?

Primary Concerns (select all that apply)

  1. Insurance Info.

Are you planning to use out-of-network benefits / superbill?
Yes
No
Unsure
If self-pay is needed, are you comfortable with self-pay rates?
Yes
No
Need Info.

  1. Safety & Consent

Are you currently experiencing thoughts of harming yourself or someone else?
Yes
No
If yes: “Are you in immediate danger right now?
Yes
No

This form is not monitored 24/7. If you’re in immediate danger, call 911 or go to the nearest ER; for urgent support call/text 988.”

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