Elevate Therapy & Wellness Intro form 
Please fill out the following questions in order to book your initial call. 

**Our therapists are not in-network providers but we will provide you with a superbill after each session that you can submit for out of network reimbursement. You can get reimbursed a certain percentage of the session based on your insurance plan.

Therapist options:
Liana, LPC-A: $175/ 50 minute sessions
Grace, LPC:  * if you want to work with Grace and are looking to heal chronic symptoms, please see link here to sign up for a call to see if it’s a good fit for our Mind-Body Healing Method Program

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Email *
Name: First and last *
Phone Number *
Where do you live? *
What are you wanting to address in therapy or coaching? *
Have you been to therapy or coaching before? *
How did you find Elevate Therapy & Wellness? *
Anything else you'd like your therapist to know before your call? *
Who would you like to schedule with? *
A copy of your responses will be emailed to the address you provided.
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