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First Name *
Last Name *
May the therapist leave a voice or text message?
Are you using insurance?
Which days of the week do you prefer? (select all that apply)
Time of day you prefer? (select all that apply)
Preference for male or female therapist?
Preference for In-Person or Telehealth?
If you would like to be seen sooner, we can offer services from our practicum interns/trainees under the supervision of a licensed therapist. Please note interns/trainees do not accept insurance, but have a flat rate.
Are you OK to be seen by an intern/trainee?