New Client Questionnaire 

Welcome! This is not a test. I want to emphasize that upfront. My goal is to ensure that we’re a good fit for each other before you pay for a session. I value your time and money, and wasting it is not something I take lightly.

Before you fill out the form, please consider the following:

  • Hourly Rates: Take a moment to review my hourly rates. They may vary based on your specific needs. 
  • Insurance Coverage: Consider your insurance coverage and how it aligns with our services.

For more details, including a list of questions to ask your insurance company and a summary of my current rates, visit the FAQs section on my website: www.mikaross.com/faqs.

Once you submit the form, you’ll receive a confirmation email. If there’s a waitlist, the email will provide our best estimate of how long you might expect to wait.

Thank you for considering working with me, and I look forward to connecting with you soon! 🌟

Email *
Would you like to schedule a free 20-minute New Client Call before scheduling? OR if Mika reviews this form and believes you're a good fit...would you just like to receive info on how to get started and how to schedule your first appointment (faster)? *
First Name: *
Last Name: *
A good email address (pinky promise we won't spam you): *
Are you, or all parties considering counseling, over the age of 18? (I don't work with minors) *
Are you looking for individual counseling or couple counseling? Think about all the things you would like to improve...if they are mostly relational, or having to do with your partner, I usually suggest at least starting with couples counseling (if possible). *
In a nutshell, tell me what's happening and where you'd like to see improvement. *
What questions do you have for me that are not answered in the FAQs section at www.mikaross.com/faqs ?
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