Name*
First Last
Phone*
Email*
Reason for Visit?*
We'll hand-pick a therapist based on your needs.
Do you prefer day, evening or weekend appointments?*
Do you have a gender or other identity preference?*
We have a diverse group of therapists.
What city do you live in?
City State

We offer tele-therapy statewide and in-person visits in select locations.
Therapy Style Preferences
- Goal-Oriented
- Structured
- Exploratory and Unstructured
- Challenging
- Supportive
Insurance Card
Accepted file types: jpg, png, gif, pdf, Max. file size: 10 MB.
We work with most insurance plans. Our intake team will check your insurance coverage and provide a copay or cost estimate. We offer in-network and out-of-network providers. If you have a PPO plan, you have out-of-network coverage. As a courtesy, we will check your deductible and copay on insurance company provider portals. However, the insurance company portals are not always accurate or updated. Checking deductibles is a courtesy we offer, however it is your responsibility to know your policy and coverage
Date of Birth
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Request App – Test Form

Services