New PatientsScheduling and Inquiries Name * First Name Last Name Email * Phone * (###) ### #### What state do you live in? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming What is your insurance? * If not using insurance write "Cash". New patient appointments are $200 without insurance. Consent to text and email * We coordinate via email and text. Please indicate you agree or don't agree to communication from us via text or email. We will not text or email you if you respond "STOP" I agree to email and text communication I do not agree to receive texts or emails Where did you find us? * Psychology Today Google Search Referral from therapist Referral from Primary Care Referred by friend Don't wish to say Are you almost ready to take the first step and schedule with us? If so, what is moving forward contingent upon? (i.e Is your insurance accepted, opening soon enough, etc.) Briefly tell us how we can help you. Currently we do not have new patient openings in this state. Our approach requires a lot of training, and we are working to meet the demand for services in your area.You are on the wait list, and we will reach out as soon as we have a sense for when we can get you in. We may be in touch with any referrals to other practices in your area that can meet your stated needs. Thanks so much for your patience. Please take advantage of all of the free resources on the website and keep advocating for the kind of services you feel you need.
