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Individual Therapy

Interested in one-on-one therapy?

Fill out this new patient interest form and we will be in touch in 3 - 5 business days.

Preferred Name

Legal Name

As listed on insurance.

Date of Birth
Is it okay to leave a voicemail at this number?
Yes
No 2
Preferred communication method
How will you be paying for therapy?
I'm interested in working on:

_____________________________________________________

The follow questions are asked to ensure that Brave Ass Scaredy Cat Counseling can honor your level of care. Thank you taking the time to share intimate info.

Have you been in therapy before?
Yes
No
Are you taking any medications at this time? This can be for medical or psychiatric reasons. If yes, we will follow up at your first session. I take a holistic approach to your treatment and coordinate with your current care providers as needed.
Yes
No

_____________________________________________________

If Brave Ass Scaredy Cat has no availability at this time:
I'd like to be placed on their waitlist.
I'll keep searching for a therapist elsewhere.
Telehealth (video calls) therapy sessions are limited. In-person sessions are Brave Ass Scaredy Cat Counseling's primary availability at this time.
I'm down for in-person.
I only want to meet via telehealth.
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