Looking forward to hearing from you!

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Please complete the information below and we will be able to check availability and get back with you within 24 hours of the information being sent on a week day, and the Monday following a request sent on the weekend.

NOTE: ABI Counseling only accepts Blue Cross Blue Shield Insurance and private pay clients. If you have insurance other than BCBS, you can be scheduled as a private pay client.

First and Last Name *

Client Date of Birth *

YYYY

Cell phone number: *

Email address *

What weekdays work best with your schedule? *

Monday

Tuesday

Wednesday

Thursday

Friday (mornings only)

Any day of the week works fine.

Required

What would be your preferred time of day to meet? *

First thing in the morning

Mid-morning

Afternoon

Evenings (after 5:00 are limited availability)

Any time of day works fine.

Required

BILLING *

I will be filing on my Blue Cross Blue Shield insurance (copays or deductible payments will apply)

I will be paying the private pay rate of $125 per 60 minute session.

Briefly describe the reason for seeking counseling:

Once you click "submit" you're done! You may be given the option to "submit another response" but there is no need to do so.

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