Intuition Collage registration

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Every Saturday
10 AM to 11:30 AM
Only at Symmetry of Self Counseling Center

Full Name *

Email *

Address *

Phone Number *

Your connection to Symmetry of Self *

Current Client

I have never been to Symmetry of Self Counseling Center

What has sparked your interest in this group? (Check all that apply!) * *

I enjoy creative arts and self-expression

I could use the social supports

I think it could help me learn more ways to cope with stress and intense feelings or behaviors.

I want to deepen my relationship with myself and my inner parts

My therapist recommended it

Other:

Required

The fee is $60 per 1.5-hour session without insurance. Insurance copay is subject to your individual plan. How will you be managing the fee? *

Using my Insurance (I only accept Aetna, Cigna, United Healthcare/Optum, Tricare, Allied Trades Assistance Program)

Paying out of pocket

Paying out of pocket and will need a super-bill for reimbursement.

You will receive an email shortly comfirming your registration.

If you are new to Symmetry of Self Counseling Center, you will be asked to create an account in our patient portal to fill in your insurance ID and other needed information. You may also receive a separate screening form to fill out to make sure that this group is appropriate for you and your needs.

If you are using insurance we highly recommend contacting your insurance carrier to find out how much a group therapy session would be (CPT Code 90853).

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