Appointment Request
Thank you for your interest in starting therapy with Mama Bear Therapy!

This form will help us get started. After completing this form, you will be contacted in 2 business days to set up your complimentary 15-minute virtual consultation.

You will receive a text message to confirm an appointment day/time that fits the preferences you indicate below.
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Email *
First and Last Name *
Phone Number *
By providing your phone number you consent to receive text messages.
I understand that I will be contacted via text message to schedule an appointment.  I consent to text messages. *
Required
Session Day Preference *
Required
Session Time Preference *
Required
How did you hear out about Mama Bear Therapy?
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Payment Preference *
Payment preference refers to after the complimentary 15-minute virtual session.

 Please note Magellan Plans, EAPs, and Medicaid are not accepted.
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