Name *

First Name

Last Name

Phone *

(###)

###

####

Who are you seeking therapy for? If for a loved one, read below. *

We are accepting individual and couples therapy clients. If you're reaching out for a loved one, please provide your contact information (not theirs), then answer the rest of the questions from their perspective to the best of your ability and schedule the phone consultation for yourself. At that time, if we believe we can help them, then we can talk about scheduling a second consultation with the loved one you're reaching out for.

Myself

A Loved One

Are you (or the loved one you're reaching out for) 18 or older? If no, read below. *

We typically only see clients who are 18 and older. We will consider those who are between the ages of 15-17 on a case by case basis. For child, adolescent and family therapy, we recommend The Center for Connection (in Pasadena).

Yes

No

What are your preferred pronouns? *

She/Her

He/His

They/Them

Do you prefer virtual, in-person in Pasadena or a blend of both? *

Virtual

In-person

Blend of both

Are the following fees within your budget for the out-of-pocket cost of psychotherapy? *

Keep in mind that we do not take insurance. The fee per session is: $165 (Pre-licensed therapist) and $250 (Licensed therapist) per 50 minutes. Although we accept private pay only, many PPO insurance companies will reimburse for some of the cost of therapy delivered by an out-of-network provider. We can make what's called a "superbill" available for you to submit to your insurance company, upon request. We also accept HSA/FSA funds, which are pre-tax dollars used to pay for approved health expenses. If your insurance company asks you which CPT codes will be used, you can tell them 90834 for 50-minute sessions. If you need our NPI or EIN number, we can provide that to you once we decide to move forward with scheduling your first session. You can use a service like Reimbursify.com to make your claim filing easier.

Yes

No

Do you have a therapist preference? *

No Preference

Megan Galloway

Lyla Connolly

Cyla Fisk