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Last name
Email
Phone
Birthday
Month
Day
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Our mental health sessions are in network with most BCBS and Aetna plans. Do you hope to use your insurance coverage?
Yes
No
Unsure
We offer telehealth and in person sessions. What do you prefer?
In person
Telehealth
Either
Unsure
When are you available for sessions? (check all that apply)
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
What kind of therapy are you looking for?
Individual therapy for myself
Individual therapy for a family member or child
Couples therapy
Briefly describe your goals for therapy
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