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Appointment Request

Please provide the following information if you are interested in setting up your first appointment.  

Your answers will allow us to determine if we are able to meet your needs. We will respond to you via email and provide instructions to submit insurance information and new client forms.  

Choose one of the following:

  • Westlake Village, CA Face-to-Face Sessions
  • Tele-remote / Video Sessions anywhere in the State of California

1. Do you wish to use health insurance for services? If so, please name your provider.  (Though we may be listed in your member portal, we may not be currently accepting certain plans.  

  • Anthem Blue Cross - Blue Cross/Blue Shield (we are not accepting Blue Shield at this time).  If you are unsure which plan you have, please refer to your member's provider list for your panel.
  • Cigna
  • Optum
  • Motion Picture Health
  • Providence
  • Tricare-West
  • United Health & all commercial plans
  • Other PPO plan (or out of network plan)

2. Are you setting up a standard visit or an EAP visit

Choose:

  • Standard 
  • EAP (requires written authorization)

3. What days of the week and time of day are you seeking services?  We see clients Monday - Thursday 10:00 am - 7:00 pm.  We do not offer weekend appointments.  Please describe the widest range of windows of time and specific days you are available.

4. What kind of therapy are you seeking? (Couples, Family, Individual, Brain Wellness Program)

5. In general, what is the primary focus for services? (Stress, Depression, Divorce related, Occupational concerns, Communication, Relationship Help, Family, etc.)

Thank you for providing answers to these questions.  We will respond within 24 business hours or less to determine the next step in setting up your first appointment!  

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Helpful Forms

Click here to view and print forms for your appointment.

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