Client Intake Form and Insurance Verification

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Email *
Name *
We only conduct telemental health in California. Is CA where you reside? *
Required
Court Mandated Therapy Notice
Unfortunately, at this time, Vantage Point does not partake in any kind of court mandated therapy. If that is something you are looking for, we recommend reaching out to the court directly for counseling referrals to ensure that you get connected with someone that can complete the paperwork that you need. Thanks so much!
Where did you find out about our services?
Are you apart of the Joy Of Medicine Program?
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Therapy Modality preference: *
Age *
Gender Identity *
Gender Preference Of Therapist  *
If gender preference of therapist isn't available would you be open to trying someone else?  *
Have you ever been in therapy before?
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What are you struggling with? *
Required
Have you been formally diagnosed with a mental health condition?  *
Anything else you would like us to know in order to best match you with an available therapist (i.e., cultural or diversity considerations, other information)?
Do you have any scheduling constraints that we should be aware of?
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