First Name
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Email
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Phone
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State
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What would you like support with?
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Anxiety, trauma, relationship struggles, identity, stress, life changes...
Anxiety or feeling overwhelmed
Depression or low mood
Relationship challenges
Healing from trauma
Life transitions or big changes
Grief or loss
Identity exploration
Burnout or work stress
Body Image Concerns
Self-esteem and confidence
Other (please share in message if you'd like)
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Therapist Preference
Is there a specific therapist you’d like to work with?
Summer Stewart, PsyD
Samreen Ahmed, LSW
Therin Slayton, PsyD
Fabiola Felix, MSW
Aretha Steele, PsyD
No preference
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How would you like to pay for therapy?
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Insurance, private pay, out-of-network reimbursement, etc
Blue Cross Blue Shield PPO
Aetna
Out-of-Network Benefits
Private Pay
Other (please explain in message)
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How can we help? Share as much or as little as you’d like.
Messaging Consent
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