305 Psychotherapy Group LLC

305 Psychotherapy Group LLC Send Message

Who would be receiving care?

Me

Someone else

Your info

First name

Last name

Email

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Reason for care

What is the reason for seeking care?

Anxiety Trauma Depression Grief Relationship issues Behavioral issues Other

Billing & Payment

Payment method

How do you plan to pay?

Insurance card upload

Upload a photo of your insurance card

Client Preferences

Preferred recurring appointment times

I currently have the following recurring weekly appointment times:

Mondays at 2 PM Tuesdays at 11 AM Wednesdays at 2 PM Thursdays at 12 PM Thursdays at 4 PM I prefer to schedule as needed

Is there anything that the you would like me to know to support my preparation of the meeting?

For example: what you'd like to focus on, types of treatment, scheduling, insurance or payment questions, etc.

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