TOC Therapy Waitlist
Thank you for your interest in working with us! Please use this form to share a bit about yourself and the services you are looking for. We will begin reaching out on January 5th to help schedule a free consultation. 
Please share your name & pronouns with us *
What email should we use to contact you? *
By checking the box below, you are confirming that you are at least 18 years old and currently live in California. *
Required
What services are you interested in? *
Required
Please share your three ideal day/times for weekly sessions. *
Paying for Therapy:
Our regular session fee for individual therapy is $175/session. However, Yesenia will offer some low cost sessions and will be able to accept insurance. Please share how you would like to pay for therapy below: 
If you would like to use insurance, please let us know which one you would like to use:  *
If not using insurance, what is your budget for weekly sessions? (N/A if not aplicable) *
Tell us bit about yourself and why you are seeking therapy. *
How did you find us? *
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