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307-207-7957
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Book Free Consult
Please fill out this form to help us find the best therapist to fit your needs and availability.
Have questions or want to talk to us now? 1 (307) 207-7957
FULL NAME
EMAIL
PHONE
BIRTHDAY
WHAT ISSUES ARE BRINGING YOU INTO THERAPY?
Have you (or the client if you're completing this on behalf of someone else) been hospitalized for psychiatric reasons within the last 30 days? *
YES
NO
Have you (or the client if you're completing this on behalf of someone else) had a Suicide Attempt within the last 6 months?
YES
NO
What time works best to schedule your sessions?
MORNING: 8am-11am
AFTERNOON: 12pm - 4pm
EVENING: 5pm - -8pm
NO PREFERENCE
What type of session are you looking for?
Choose a type of session?
How will you pay for services?
OUT OF NETWORK Courtesy Billing for BCBS, Anthem , United Health Care, UMR, Optum
PRIVATE PAY
Skip if not using insurance | Please provide the MEMBER ID from your Insurance Carde
Insurance Company
SUBMIT
Thank you! We’ll be in touch.
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