Waitlist Request Form

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Thank you for your interest in scheduling an appointment with us!

Unfortunately, appointment offerings for new clients are very limited at this time. If you'd like to be added to our waitlist, please complete the form below and we will get back to you ASAP and let you know the new client/waitlist status.

Before completing this form, please review the following answers to Frequently Asked Questions to make sure our practice meets your scheduling needs.

Appointments are offered M-F between the hours of 10 a.m. - 4 p.m.
Our office is in-network with Aetna commercial plans only (we do not accept Medicare or Medicaid plans).
For clients without insurance, or who have an insurance plan that is not Aetna, our self-pay rate is $150 per session.
We work exclusively with individual adults and do not provide services for children or couples.

First and Last Name *

Email *

Phone # *

Insurance *

Aetna

Self-pay (no insurance)

Self-pay (non-Aetna insurance)

Appointment Type Preference *

In-person

Telehealth (clients must be located in AZ at the time of the appointment)

Combination

Contact Type Preference *

Phone call

Text

Please share a brief description about what brings you to counseling at this time. *

Submit

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