First Name *

Last Name *

Phone *

Email *

Are you requesting services for yourself or someone else? *

Self
My child who is under 17
My adult child 18+
Couples Counseling
My relative or partner
Other
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Client's Age *

Preferred Therapist

How Did You Hear About Us? *

Google/Internet Search

Friend/Family Member

School Counselor

Pediatrician/Primary Care/MD

Social Media

Other

Your Message *

We offer in-person services in two office locations and telehealth services. Check all options you would be comfortable with. *

Scotch Plains (Union County)

Branchburg (Somerset County)

Telehealth

Appointments are generally scheduled weekly. An appointment is 45 minutes. The initial intake can vary from 90 minutes to 2 hours. *

I understand

Fees range depending on licensure status and degree. The fees range from $185-$265 for the initial intake session and $135-$190 for weekly ongoing sessions. *

I understand

For a full description of fees visit our Practice Information page.

We are an out-of-network provider. We do not participate directly with your insurance. You will be required to submit payment at the time of your appointment. *

I understand

On your call we will discuss how to learn about your out of network benefits. If you have out-of-network benefits, your therapist will give you a receipt. You can submit the receipt to your insurance, and they may reimburse you depending on your out-of-network benefits. *

I understand

Email and SMS Text Message Risk Acknowledgement and Use Consent *

I understand that the use of email and SMS text messages are inherently insecure and thus poses a risk to the security and confidentiality of my protected health information and I consent to our therapists and/or office staff communicating with me via email or text message

By providing my phone number, I agree to receive text messages from the business.

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