Waitlist - Tiana Leeds, LMFT

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Email *

First and Last Name *

Phone number *

I am seeking therapy for: *

Myself

Other:

Required

To which gender identity do you most identify?

Date of birth

What city do you live in?

How did you hear about me?

May I thank this person?

Yes

Not Applicable

Other:

Clear selection

Please add me to the waitlist or interest list for (check all that apply; all individual sessions are offered via phone or video):

Individual Therapy - waitlist

Individual Coaching - waitlist (as compared to therapy, coaching is more focused on the present and future; it also addresses your past to the extent that it is impacting your current life or getting in the way of you reaching your goals)

Course for Highly Sensitive People - interest list

Course for Healing Your Inner Child - interest list

Group Coaching for Highly Sensitive Women - waitlist

Group Coaching for Healing Your Inner Child - interest list

Please include me on emails announcing upcoming offerings and sharing recent insights

Other:

I prefer to meet via:

Phone

Video

Either phone or video, depending on what type of spot opens up first

No preference

Do you consider yourself a highly sensitive person (this is not a prerequisite for working together)? See https://www.tianaleeds.com/high-sensitivity if you'd like to know more about high sensitivity.

Yes

Sounds like me...maybe

Not sure

Other:

Clear selection

What brings you to seek support at this time? Is there something specific, such as a particular event?

What are your initial goals in our work together?

The session fee as of 1/1/2022 is $225 per 45 minutes for individual therapy and coaching (longer sessions are prorated). If these rates change before we begin, you will be updated. Group rates vary depending on the program offered. While I am not an in-network provider with any insurance panels, I am happy to provide "Superbills" for you to provide your insurance for possible reimbursement. Session fee is due on the day of service regardless of whether you plan to seek insurance reimbursement.

Got it, this works for me.

This could work for me if I were able to have an every-other week session schedule.

This won't work for me. I will seek out other resources, eg via psychologytoday.com/us/therapists or hsperson.com/therapists/.

Not Applicable - I am interested in group coaching and/or online courses, rather than individual sessions

Other:

Clear selection

Are you interested in seeking reimbursement for therapy from your insurance company? If so, please check with your insurance to determine coverage. Please note that Superbills include applicable diagnoses in order to qualify for reimbursement. Key questions to ask your insurance company include: Do I have mental health insurance benefits? What is my deductible and has it been met? Do I have a separate deductible for mental health? How many sessions per year are covered? Is prior approval required from my primary care physician? What is the coverage amount per therapy session for an out-of-network provider (you may need to provide my zip code - 93130 - or the procedure code - 90834)?

Yes, I am hoping to have my insurance reimburse me for sessions

No, I am planning to pay out of pocket

Undecided, I might seek reimbursement from my insurance

Clear selection

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