Phone
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Email
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Which therapist do you prefer to meet with? (We will check their availability and, if availabile, they'll contact you directly.)
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No preference Marianne Redmond Lopez Chey Davis Diana Varughese Nedra Smith Sidney Bohanen Kim Evans Lara Batayeh Beth Cherin Stacey Kaminski Raymond Bryant Kayla Glitz Ali Asad Somjee
Which therapist do you prefer to meet with? (We will check their availability and, if availabile, they'll contact you directly.)
Please select a second choice. (We will check their availability and, if availabile, they'll contact you directly.)
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No preference Chey Davis Diana Varughese Nedra Smith Sidney Bohanen Kim Evans Lara Batayeh Beth Cherin Stacey Kaminski Raymond Bryant Kayla Glitz Marianne Redmond Lopez Ali Asad Somjee
Please select a second choice. (We will check their availability and, if availabile, they'll contact you directly.)
Which dates/times work best for your first appointment? Please specify two, a first and a second option.
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If you will be using insurance, which plan do you have?
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Aetna Blue Cross Blue Shield Priority Health Cigna UHC/Optum Other I won't be using insurance. I'd like to do private pay.
If you responded 'other' above, please specify. Otherwise type 'N/A' here. We will check your out-of-network benefits for you.
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Please briefly describe what you are seeking therapy services.
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If you are human, leave this field blank.
