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New Client Inquiry Form
I invite you to complete and submit this New Client Inquiry Form. Please answer all questions, and I will then be in touch within 24-48 hours to schedule your complimentary 20-minute consultation call.
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First and Last Name
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Your answer
Email (This will only be used for scheduling purposes)
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Your answer
Address, City, State
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Your answer
Phone number
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Your answer
Age
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Your answer
Which are you primarily interested in?
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In-person (Hanover, MA) - Mental Health Counseling
Virtual - Mental Health Counseling (must be in Massachusetts)
In-person (Hanover, MA) - Emotional Wellness Yoga
Virtual - Emotional Wellness Yoga (worldwide)
Professional Mentoring & Consulting for therapists and yoga teachers (worldwide)
Corporate Wellness Programs, Speaking Engagements, Podcast Interviews (worldwide)
Other:
Required
How did you hear about Joanna Barrett Therapy & Wellness?
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www.joannabarrett.com
Zencare, Psychology Today, Mental Health Match, or Therapy Den online directories
The Wellness Collective
Google or Internet Search Engine
Referral from a current or former Mental Health Professional
Referral from a Colleague, Friend or Family Member
Required
What are your main concerns that you are seeking help for?
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Your answer
Which state(s) will you be attending our virtual sessions from? (please list all that apply)
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Your answer
All Sessions are Private-Pay:
$250 for intake & $225 for individual sessions
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Therapy - I will private-pay.
Therapy - I will private-pay and be claiming Out-of-Network benefits; I will need a monthly receipt/superbill for insurance submission
All wellness services are self-pay and cannot be submitted to insurance.
Required
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