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.

My insurance-based time slots are currently full. The below information will be utilized as part of my wait list as spaces open if you want to utilize insurance. Please note the wait may be weeks to months. 

Self-pay time slots that I have available are as follows:
  • Mondays at 10 am, weekly
  • Mondays at 11 am, bi-weekly
  • Mondays at 1 pm, weekly
  • Mondays at 5 pm, weekly
  • Tuesdays at 10 am, weekly
  • Wednesdays at 7 pm, bi-weekly
  • Thursdays at 4 pm, bi-weekly
Thank you again. I'm glad you're here.
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Email *
Your name:
Your pronouns:
Do you live in Pennsylvania? I am only able to provide therapy to Pennsylvania residents at this time. Even virtually, the Client must be within PA state limits! *
Do you plan to utilize insurance? If yes, please indicate what plan you will be using:
Which of the following self-pay time slots are you available / interested in? Select all that may apply.
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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