Practice Waitlist Form
Please answer the following questions in order to be placed on our waitlist.

It's hard to predict how long you may be on the waitlist since it depends on a variety of factors such as who you're interested in seeing and if their availability aligns with your availability. Some people are the waitlist for a few weeks; others are on it for a few months.

If a therapist you're interested in seeing has an opening for a new client that works with your availability, the therapist will reach out directly to you to schedule a consultation or appointment.

If you need care sooner than later, we're happy to add you to our waitlist but encourage you to continue looking for a provider.
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Your name *
Email address *
Phone number *
Preferred method of contact
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Which therapist(s) are you interested in seeing? *
If you're unsure of who might be a good fit, you can complete our Matchmaking Form and our administrative team will match you with a therapist with aligned areas of passion, expertise, and availability.
Do you have a preference for telehealth or in-person therapy? Please note that we have limited availability for in-person therapy. *
If you'd like in-person therapy, please indicate which locations(s) you prefer.
When are you available for a weekly therapy session? *
From a high level, what are the top 2-3 things you're looking to work on in therapy? *
How did you hear about Balanced Awakening? *
Are you planning to use health insurance to cover your sessions or will you be self pay? *
Balanced Awakening is in network for BCBS PPO, BCBS BlueChoice PPO, Aetna and Tricare. Our self pay rates are $235 per session for the first two intake sessions and $210 per session after that. 
If you are planning on using health insurance to help with the cost of therapy, what is your Member ID? Please include any letters as well as numbers. 
(This will allow us to expedite the process of sending you an estimate of coverage)
If you are planning on using health insurance to help with the cost of therapy, what is your date of birth? 
(This will allow us to expedite the process of sending you an estimate of coverage)
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Is there anything else that would be good for us to know? (optional)
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