Discovery Call > Start Here

STEP 1 OF 4

1. Send Interest Form > 2. Payment for Discovery Call ($)> 3. Schedule Your Call

1. Application > 2. Review > 3. 1-on-1 Call > 4. Book

SEND THIS QUICK FORM

*Note this form does not save. Copy and paste answers as a backup method, if needed.

First Name *

Last Name *

Email Address *

Phone Number *

How did you hear about me? *

Are you planning to use insurance?

Yes, I have insurance, and, would like to use.

No, I do not have, or, am not planning to use insurance.

Does not matter, or, whichever is ideal.

Unsure.

Have you ever been in therapy? [Type] *

Have you ever been in therapy? [Time] *

What therapy are you interested in primarily? *

What brings you to inquire about therapy? Why now? *

[Final Thoughts]

How will you know if our call has been productive and/or helpful? *

Any additional information you'd like to share?

Captcha