Thank you for reaching out.

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Here are a few important things to know about Amy Dunn Counseling.

I do accept most forms of BCBS and this is the only insurance I accept.
Self pay rate is $170 for a 55-minute session or $510 for a 3-hour intensive session.
All intensives must be paid for out-of-pocket, regardless of insurance coverage.
You must be in North Carolina at the time of our sessions.
All sessions are virtual.

Please provide some information regarding scheduling availability and counseling needs.

Email *

Name *

Best phone number to reach you at.

Where did you hear about me? *

Scheduling Availability

Weekly sessions are generally scheduled for the same day and time each week.

Whenever possible, biweekly sessions are scheduled every other week at the same day and time. In order for this to work, I need to be able to pair two people together with similar availability. When it is not possible to line up schedules in this way, the day and time of your appointments may vary.

All sessions are conducted virtually.

What is your scheduling availability?

Please check as many as apply.

Morning

Lunchtime

Afternoon

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How frequently would you like to meet?

Weekly and biweekly sessions are approximately 55 minutes long.

Intensive sessions are 3 hours long and the frequency is variable based on your goals. These can be done on their own, or in addition to weekly/biweekly therapy.

Please check all that apply.

Weekly.

Every other week.

I am interested in intensive sessions.

I'd like to hear more about intensives before I decide.

A different frequency (please make a note of what you are looking for specifically below).

Required

Is there anything else you'd like me to know about how often you'd like to meet, or your availability?

How do you plan to pay for your sessions? *

I have Blue Cross Blue Shield (BCBS) and I plan to use my insurance.

I plan to pay out of pocket for my sessions.

What to you want to work on in counseling? Please check all that apply. *

Anxiety and/or depression.

Processing traumatic events.

Issues related to parenting a child with special needs.

Learning to regulate my emotions.

I am specifically interested in working with a trained Internal Family Systems (IFS) therapist.

Other (please make a note of what you want to work on below).

Required

If there are any additional issues you want to work on in counseling, please list them here.

Thanks so much!

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Amy Dunn Counseling. Report Abuse

Forms