Welcome-v2

1Personal Information

2Therapy Preferences

3Insurance Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

I'm looking for therapy for

Myself

My Child

Couples or Family

Someone else

Child's Name(Required)

First Last

Child's Date of Birth(Required)

Potential Clients's Name(Required)

First Last

Child's Date of Birth(Required)

Is there a custody agreement where both parents share medical decisions for the child?(Required)

Yes

When billing your insurance for couples therapy we are required to perform an initial intake assessment with the person who’s insurance we are billing before couples sessions may begin. We are required to assess for medical necessity before seeing both parties. What this means is the insurance holder will attend the first session alone to meet with the therapist.

Welcome Form

About

Office Locations

California

West LA Office

Studio City Office

Pasadena Office

Nevada

Henderson Office

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