Completing the form below will add you to our wait list. Once completed, be sure to hit the “Submit Request for Services” button at the bottom and wait for a “Thank You!” screen confirming that your submission has been sent. If you indicate your intention to use insurance, please be aware that completing this form does not guarantee that your insurance plan will pay for our services. Once we reach your place on the wait list, we will confirm that you have an active plan through an insurance company with whom we are in-network.

If you intend to use insurance, please take the following proactive steps:

• Contact your insurance company and determine your mental health benefits, and that our providers are in-network. If your claims are rejected because we are not in-network, or because your benefits do not cover our services, please be aware that you will be responsible for paying our out-of-pocket rate ($140 per 60 minutes).
• Make sure that your mental health benefits are not “carved out” to another insurance company. This is when an entirely different insurance company handles your mental health coverage. If you have a “carve out” and we are not in-network with the contracted insurer, you will not be able to use your insurance with us. Be sure to rule this out with your insurance company when you call. This information is also sometimes written on the back of your insurance card.

You MUST include ALL current insurance information, including accurate primary AND secondary insurance and member IDs for each plan. Failure to provide ALL insurance information accurately may result in delays with your placement with an appropriate therapist for your specific insurance.