First Name *

Last Name *

Phone *

Email *

Are you looking to book therapy for yourself or with a family member?

Partner/Family Member First Name

Partner/Family Member Last Name

Partner/Family Member Email

If requesting couple's or family counseling, please enter the email for the other member of the couple or at least one family member that will be involved in counseling

Preferred Appointment Type(s)

What times work best for you? *

Morning (6AM-10AM)

Midday/Lunch (11AM-1PM)

Afternoon (2PM-4PM)

Early Evening (5PM-8PM)

Preferred Method of Communication for Booking an Appointment? *

Phone Call

Any combination above works for me!

If other, please specify:

Provider I'd like to see:

Megan Lawler, MSW, LCSW

Sierra Sheriff, B.S., MA

Kayley Schwab, B.S. (Graduate Intern)

Anna Charlebois, B.A. (Graduate Intern)

Help Me Decide

Need More Info (set up a free 15 min. consultation)

Since you select "Help Me Decide," please select from the following options:

I need the most experienced

I need the most affordable

I need the one I can see the quickest

Insurance/Payment Options *

Use my out-of-network benefits (pay for services up front & we can provide information on how to get some reimbursement from your insurance company)

Health Savings Plan

Lyra Health

**NOTE: Our providers are NOT in network with any insurance. Insurance Provider Lists are often incorrect and out of date. We can assist you with the needed information and user friendly options for submitting bills to your insurance to check your "Out of Network" benefits. All session fees will be required up front when filing Out of Network.** *

I understand and I know how to do this

Any questions or additional information we should know: *

Messaging Consent

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