Do you live in California?
*
Name
*
First Name
Last Name
Email Address
*
Phone
(###)
###
####
I'm interested in:
*
What would you like to work on in therapy? (Please list your top 2-3. There'll be more opportunity to go into detail on your intake forms.)
*
If you selected 'other,' tell us more about what you'd like to work on. This will help us match you with the therapist who's the best fit.
Do you identify with any of the following? (If not, that's totally ok!)
If you are a parent or guardian scheduling for your teen or young adult, what is their age?
If you have a preferred therapist(s), just select them below.
If not, no worries! We'll help you get connected with the support that's right for you.
Do you prefer to meet weekly or biweekly (every other week) with your therapist?
*
We schedule appointments on a weekly or biweekly basis because we know this consistency makes therapy most effective.
Please identify a few possible days and times that you could be available for an appointment on a recurring weekly or biweekly basis.
*
EVENING and WEEKEND slots fill quickly.
How do you prefer to meet with your therapist?
*
Please note that not all of our therapists offer in-person appointments at this time.
Form of payment
*
If you'd like to use your Out-of-Network insurance, what insurance do you have for mental/behavioral health? (If not, just type N/A or none.)
*
How did you first hear about us?
*
How do you prefer for us to contact you?