Appointment Request

Please provide the following information if you are interested in setting up your first appointment.  Our practice is typically quite full.  We apologize if we cannot fit your availability into ours.  We hope you understand.

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.  

Currently, we offer only Tele-remote / Video Sessions anywhere in the State of California.  We have no plans to return to office services in the future.

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.  

Plans we are accepting, based on availability:

  • Aetna Commercial Plans
  • Anthem Blue Cross - Blue Cross/Blue Shield (we are not accepting new patients with Blue Shield, MHN, Cigna, TriCare, or Magellan).  
  • Optum Health
  • United Health & all commercial plans

OTHER

  • PPO plans (or out of network plan)
  • Self pay - cash or credit card

2. Are you setting up a Standard Therapy Session or an EAP visit

Choose:

  • Standard Behavioral Health  Visit   (preferred) 
  • EAP (requires written authorization) -  provided by employers as a benefit

3. What days and what time of day are you seeking services?  Please list the widest window you are available.

We see clients Monday - Thursday 11:00 am - 5:00 pm.  

            We do not offer Friday, evenings or weekend appointments.  

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

We are taking individual adult clients, only, at this time.  

5. In general, what is the primary focus for services? (Stress, Depression, Divorce related, Occupational, 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.

Schedule Appointment

Start your new path in life and be the change today!

Click Here

Helpful Forms

Click here to view and print forms for your appointment.

Click Here