Appointment Request Form

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for session with Ryan Shea, Psy.D

Thank you for your interest in scheduling a first appointment, and congratulations on taking a major step toward improving your mental health. Please take a moment to answer a few questions that will help me get a better sense for how I might help meet your needs. You can expect to hear from us in 2-3 business days.

Client Name *

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Treatment Modality *

Individual Therapy

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Please briefly describe what you hope therapy will help you address *

Insurance Provider *

Email *

Phone Number

How did you hear about Dr. Shea?

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Psychology today

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