Request Appointment

    We’re glad you’re here. Complete this request form and our intake team will match you with a therapist based on your needs, preferences, insurance, and availability.

    Who are you completing this form for?*

    Your information

    Please share your information as the person completing this form.

    Prospective Client Information

    We must be able to email you to complete the intake process. Please check your email daily.

    Which other types of communication do you consent to?


    Which type of therapy are you requesting?*

    Select all that apply.

    Information for clients under 18

    Please select all that apply:

    If both parents/legal guardians have legal rights, please list the other parent/guardian’s information:

    Relationship/Family Therapy Participant Information

    The prospective client’s information was collected above. Please enter information for any additional participants.

    How many additional participants will be joining therapy?*

    Additional Participant 1




    Additional Participant 1




    Additional Participant 2




    Additional Participant 1




    Additional Participant 2




    Additional Participant 3




    Therapist Preferences

    Do you have any therapist preferences?

    Select all that apply. Therapists of color currently have virtual appointments only. LGBTQIA2S+ therapists have both in-person and virtual appointments.

    What type of appointment are you open to?*

    Are you open to being seen by a master's level intern?*

    Please briefly tell us what brings you to therapy.*

    What is your availability for appointments?*

    Please include days, times, and whether you prefer morning, afternoon, or evening appointments.

    Payment Information

    How will therapy costs be covered?*

    Insurance Information

    How many insurance plans will you be using?*

    Not sure which plan is primary or secondary? That’s okay. Please answer as best you can and our intake team will help verify your benefits.

    Your insurance plan

    Please upload the front and back of your insurance card if you have it available.

    If you do not have it right now, our intake team can follow up by email.

    Second insurance plan

    Please upload the front and back of your second insurance card if you have it available.

    If you do not have it right now, our intake team can follow up by email.

    Please upload the front of your identification or driver's license if available.

    If you do not have it right now, our intake team can follow up by email.

    Anything else you’d like us to know?

    If you have a specific therapist you would like to be matched with, you can add their name here.

    Next Steps

    You will receive an email response the same day or next business day. We’ll send your estimated cost per appointment and your first therapy appointment date/time. If that date/time does not work, you can reply and let us know.

    We will also send you a link to complete intake forms. Forms must be completed before your first therapy appointment.

    Consent to submit this form

    Please review and accept the statement below before submitting.