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Waitlist For Therapy With Emily Cooper
Hi! Thanks for your interest in receiving therapy from me! Please fill out the form below and I will be in contact with you when I have openings.
Thanks!
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Name (first and last)
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Your answer
Phone number
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Your answer
Email address
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Your answer
Reason for seeking treatment?
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Your answer
Is it ok to text the number above?
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Yes
No
Is it ok to email the email address above?
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Yes
No
I do not take insurance, however I am able to provide you with a receipt if you'd like to seek reimbursement on your own. (Read the "pricing" section of my website for information on how to know how much they'll give you back.)
The initial consultation sessions is $200 and subsequent sessions are $150. Please confirm you have read and understand this.
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I have read the above and confirm.
I am only able to meet with clients who are current residents of Utah. Please confirm this applies to you.
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I am a resident of Utah
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