Please fill out the information below and I’ll be in touch soon! Afternoon time slots are the most requested, so be please note there may be a wait period before an afternoon time is available. Name * First Name Last Name Child's First and Last Name (if child is the client) (Child must be at least 13 years old) First Name Last Name Date of Birth * Phone * (###) ### #### Email * What state do you currently live in? * I am only able to provide services for clients who are located in Missouri or Kansas. Kansas Missouri What service are you interested in? Individual Counseling What type of therapy is best for you? * In person Telehealth Both What brings you to therapy? * What goals do you have for yourself? * Do you currently have any medical diagnoses? If so, what are they? * Please include medication, if applicable. What is your desired frequency for sessions? * I do not currently take new clients who wish to be seen less frequently than every-other week. After we work together for some time, we may decrease your frequency to an "as-needed" or "monthly maintenance" frequency. Weekly Bi-Weekly What is your preferred day and time for sessions? * Please indicate any available times for sessions below. My current openings are limited to Tuesdays and Wednesdays. If none of the listed slots work for you but you're still interested in working with me, please mark your availability, and I will do my best to accommodate. **Appointments are scheduled on the hour, with the last appointment of the day starting at 3:00 PM. Tuesday Morning (9-12pm) Tuesday Afternoon (1-3pm) Wednesday Morning (9-12pm) Wednesday Afternoon (1-3pm) The following information is a brief overview of my therapeutic approach: * We will dive into your past relationships and experiences to gain insight into your current patterns. If you prefer not to explore your past, I may not be the right therapist for you. Our focus will be on emotional processing by helping you identify, understand, and feel your emotions. Multiple therapy modalities may be used to meet you where you are at. If you do not wish to concentrate on your emotions, I may not be the right therapist for you. We will work collaboratively. While I bring mental health expertise, you are the expert on your life, guiding our understanding of your experiences. You will have control in our sessions, deciding each week what to focus on. We will embark on a long-term journey of exploration and healing. While we will address short-term stressors, this process is not a quick fix; it will take time. Do you have any questions or concerns regarding my approach? No, this all makes sense to me & I am good with the above! Yes, I have questions & would like to chat more about this. The following information explains some of my policies regarding payment: * My rate is $150 for a 55-minute individual session. These are my private pay fees. I do accept the following insurances: Aetna, BCBS of KC, Cigna, and Optum (UHC). Insurance fees are different for each plan so please contact your insurance beforehand to be aware of what is covered. I do require all clients to have a card on file in the case of late cancellations and or no shows. Late cancellations or no shows are charged the full private pay fee. If you are using insurance, this fee is not covered by insurance. More detailed information is in my policies. Do you have any questions or concerns regarding payment? No, this all makes sense to me & I am good with the above! Yes, I have questions & would like to chat more about this. If you are using insurance, please select your provider. I accept most insurance plans; however, there are some with which I am not in-network. To ensure coverage, eligibility checks are conducted prior to scheduling appointments. Please note that I am unable to accept Medicare or Medicaid at this time. Aetna BCBS Cigna UHC I would like to use Private Pay I understand that I will be responsible for the entire session fee if I cancel less than 24 hours prior to the scheduled session or if I am a No-Show to a scheduled appointment. Sessions are considered a "No-Show" if I am 10 minutes or more late. Yes Additional information you feel I should know: Thank you! I will be in touch by either phone or email within two business days.