Client interest form
We currently do not have immediate openings to take on new clients. It is a possibility some spots may open in May. If you would like to be contacted if something opens up that meets your needs please fill out this form below. Filling out this form does not guarantee you will be contacted.  If something becomes available within two months of your inquiry we will contact you to schedule a free 20 minute phone call to determine if we are a good fit. 

We know finding a therapist can be frustrating. Please visit our website for ideas of other resources and places to look for therapists.  If you are in need of immediate assistance (feeling suicidal or a danger to yourself or others) please call 988 or go to your nearest emergency room, as you may not get a response from this form if there are not openings that might accommodate your needs.  Those in crisis in Charlottesville and surrounding areas can call 434-972-1800 to request Region Ten Emergency Services. 
Full Name *
Email *
Phone Number *
Briefly describe why you are interested in therapy at this time.  *
Currently we are only in-network with Anthem BCBS.  We can help you learn how to file for out-of-network benefits if you do not have this plan or you may pay privately. There are some benefits to paying privately including not being required to be assigned a diagnosis, therapy does not need to be deemed medically necessary, insurance companies cannot dictate the type or length of care you receive, and they will not have access to your records. Please indicate below which method you choose to use to pay for services: *
Please list all days and times Mondays through Thursdays you are available 9:30am-4:30pm or indicate if your schedule is flexible. Please also indicate if you are looking for weekly sessions or biweekly sessions. Normally we start with weekly sessions in order to build a strong relationship.  *
What type of therapy are you interested in?  *
How did you find out about us?  *
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