New Client / Waitlist Form
Welcome, and thank you so much for being here. Reaching out to a therapist is a big step, and I want to acknowledge the courage and care it takes to get to this point. I’m truly grateful you’ve found your way here.

This form is the first step in helping us determine whether my services are a good fit for your needs. Right now I am on a wait list for all services. Once a space opens up, I’ll follow up to offer a brief 15–20 minute phone call so we can connect, answer any questions you may have, and see how it feels to take next steps together.

As of right now:
  • All sessions are currently held virtually. 
  • My current openings: bi-weekly at 10 am on Thursdays, 2 pm on Mondays, and weekly 3 pm on Thursdays. Please indicate below which of these time slots interests you.
  • I accept Aetna, Cigna, Highmark, and Optum insurance plans.
  • Submitting this form adds you to my wait list, and I’ll reach out as soon as an opening becomes available.
If anything here feels confusing or you need support along the way, please don’t hesitate to reach out: lori@lorizaspel.com.
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Email *
Your name:
Your pronouns:
What is the best phone number to reach you for a 15-minute consultation call?
Do you live in Pennsylvania or Florida? I am only able to provide therapy to Pennsylvania and Florida residents at this time. Even virtually, the Client must be within PA or FL state limits! *
When I have openings, I have session availability 10 am -5 pm Monday through Thursday. If you need evening sessions, I am not likely to be a good fit. Are you able to do daytime, weekday sessions?
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Do you plan to utilize insurance? Please indicate what insurance provider you will be using:
If you are NOT using insurance, what level of sliding scale payment best fits your situation? Please include the dollar amount you have determined works for your budget. You will be asked to self-identify this number! You can also refer to my sliding scale page here for assistance: https://www.lorizaspel.com/sliding-scale
What concerns are you hoping to address in therapy at this time? *
Any other questions or concerns I can answer for you?
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