Listen Counseling Center | SimplePractice

Listen Counseling Center Send Message

Who would be receiving care?

My partner and me

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Reason for care

What are you experiencing lately?

Worry or racing thoughts Feeling sad or hopeless Panic attacks Sleep problems Hard time focusing Unwanted thoughts or memories Feeling numb or disconnected Relationship problems Overwhelmed by emotions Something else

What kind of help are you looking for?

Individual Counseling Couples/Relationship Counseling DBT skills group Not sure yet

Check anything that applies to you:

This helps me understand your background. We'll talk more during our free consultation video call.

I'm in therapy now I've been in therapy before I'm taking medication for mental health now I've taken medication for mental health before I've had thoughts of suicide before I've been to the hospital for mental health reasons None of these apply to me

Are you having any of these thoughts right now?

If you checked any box, we'll make a safety plan during our first call.

Thoughts of suicide Thoughts of hurting yourself Thoughts of hurting someone else None of these

Administrative

Referral source

How did you hear about me?

Psychology Today or another therapist directory Google search Friend or family Another therapist Social media Other

Billing & Payment

How are you planning to pay?

I'm out-of-network with all insurance. You pay me first, then Mentaya automatically submits your insurance claims for you and gets you reimbursed (usually 50-80%). Check your benefits with the Mentaya tool on my website homepage - it takes 2 minutes!

Credit/Debit/FSA/HSA card Insurance (Mentaya will handle my claims) I'm not sure yet OpenPath Collective member Therapy voucher

Client Preferences

Is there anything else I should know?

For example: what you'd like to focus on, insurance or payment questions, accessibility needs, etc.

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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

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