New Client Form
First of all, thank you so much for being here. It's not easy to connect with a therapist - I want to recognize and appreciate all the steps that got you here today. These questions will help us to determine whether and which of my service offerings are a fit. Then we can take some time 1:1 to see how you feel about me, usually a 15-20 minute phone call. If you have any questions or concerns, please don't hesitate to reach out via email at lori@lorizaspel.com. Once I have some information about you, I can let you know what time slots I have available!

Thank you again. I'm glad you're here.
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Email *
Your name:
Your pronouns:
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! *
Do you plan to utilize insurance? If yes, please indicate what plan you will be using:
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 at this time?
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