Songbird Counseling, LLC Therapy Waitlist

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Please complete this form to be added to Cristy Urton's waitlist for individual therapy. I will reach out to you in June 2022 to schedule a free 15-minute phone consultation to determine if we are a good fit. Thank you!

Email *

First Name *

Last Name *

Phone Number *

How did you hear about my practice? *

What brings you to therapy at this time? *

Are you planning to use Out of Network Benefits or self-pay for therapy sessions? *

Out of Network (Please check beforehand with your insurance company if you are eligible to see an out of network mental health provider).

Self-pay (I will send you my current self-pay rates and sliding scale if eligible)

My office hours are Monday to Thursday, 8am to 4pm. Would that work with your schedule? *

Yes

What is your availability for sessions? Please be specific eg: Tuesdays between 11am- 2pm *

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