Make an Appointment

Please complete our form in order to helps us find the perfect therapist for your needs. (We do not accept insurance for Couples Therapy.)

Step 1 of 5 - We're Here to Support Your Journey. Please Provide Your Contact Info So We Can Get in Touch.

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We're Here to Support Your Journey. Please Provide Your Contact Info So We Can Get in Touch.

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Name(Required)

First Last

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Email(Required)

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Phone(Required)

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Tell Us a Bit About Why You Are Here.

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Which Type of Therapy or Coaching are You Seeking?(Required)

Individual

Couples (Private Pay Only)

Both Individual and Couples

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What is Your Reason for Seeking Our Help?(Required)

Anxiety/Stress

Communication/Connection Issues

Dating Coaching

Depression

Family Issues

Divorce Prevention

Gender Issues

Infidelity

Porn Addiction

Sex/Desire/Intimacy Issues

Trauma

Other

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How Can We Help You?(Required)

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Tell Us Your Session Preferences.

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How Would You Like to Work with Your Therapist?(Required)

Video Session

On-Site Session

Phone Session

Texting (Private Pay Only)

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What are Your Ideal Days for a Session?(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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Just a Few More Preferences - We Want to Match You with the Right Therapist

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What are Your Ideal Times for a Session?(Required)

Early Morning

Late Morning

Lunch Time

Afternoon

Early Evening

Late Evening

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What is Your Payment Method? (COUPLES THERAPY is PRIVATE PAY Only)(Required)

Private Pay (With Dr. Amanda, $500 Per Session)

Private Pay (COUPLES THERAPY, Text Therapy, Dating Coaching and Clients Outside of CT)

Private Pay (Low Cost Sessions with Interns/LMFT-A's)

Anthem BCBS of CT

Cigna/Evernorth

Husky Medicaid

United Optum or Aetna (Out of Network)

VACCN1 for Veterans

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Almost Done!

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How Did You Find Us?(Required)

AASECT

Google / Search Engine

I'm a Former Client

Insurance Website

Psychology Today

Referral/Word of Mouth

Social Media

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Would You Like to Receive Texts About Appointments? (Message and data rates may apply. Frequency varies based on appointments.)(Required)

Yes, Send Me Texts

No Thanks

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