Teresa Yeh, LICSW - Free Phone Consultation Request Form
Please fill out this form to help me know how to best reach you for a 15 minute free phone consultation.

The aim of this call will be to discuss what you are looking for, and whether we might be a good fit to work together.

You can also reach me at contact@teresayeh.com with any additional questions or concerns.

I look forward to connecting with you soon!

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Full Name *
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Age *
Email Address *
Phone Number *
What is your preferred way to be contacted? *
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I am currently looking for: *
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What day/times could you generally be available for appointments? Please check all that apply.
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What day/times are best to reach you for a free 15 minute initial phone consultation? Please check all that apply. *
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Mornings (9-12 pm)
Afternoons (12-5 pm)
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Anything else helpful for me to know about your schedule or how to best reach you?
I understand that you (Teresa Yeh, LICSW) are not in-network for any insurances at this time, and can only accept private pay and/or offer Superbills for out-of-network reimbursement at this time. *
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