Name *

First Name

Last Name

Phone *

(###)

###

####

Can we text you? *

Yes

No

What kind of therapy are you interested in? *

Couples

Individual

Family

Partner's Name (if applicable)

First Name

Last Name

Location *

I am interested in virtual appointments only

I am interested in in person appointments only

I'm open to virtual or in person appointments

Are you currently able to invest in yourself and/or your relationship? *

Our therapists' fees vary based on licensure, years of experience, additional trainings and certifications, etc.

Yes I am ready and able to invest $125/session in myself and/or my relationship.

Yes I am ready and able to invest $175-250/session in myself and/or my relationship.

Yes I am ready and able to invest $300-350/session in myself and/or my relationship.

Yes I am ready and able to invest $400-450/session in myself and/or my relationship.

I am not able to invest at this time, but would like information on some lower cost supports.

Are you located in New York? *

Yes

No