First Name
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Last Name
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Email
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Phone
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Please provide a brief summary describing your goals in therapy or the type of support or services you are seeking:
Any questions or additional information we should know:
We are a self-pay only office. However, we can provide a SuperBill for you to submit to your insurance provider for potential reimbursement.
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I understand.
We can only provide services in the state of California. Check here to confirm you reside in California:
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Yes, I/we reside in California.
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