New PatientsScheduling and Inquiries Name * First Name Last Name Email * Phone * (###) ### #### What city do you live in? 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, Soonest available slots, etc.) Briefly tell us how we can help you.
