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Individual Therapy Form
Thank you for choosing Healing Her to walk with you on your healing journey. You are so amazing and so brave! This is an important step and we do not take it lightly. Please fill out the form below to help us learn more about how we can assist you. 

Self-pay rates for sessions: $150 initial intake | $135 60 minute sessions 
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Today's Date *
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What is your first and last name *
Date of birth  *
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What is the best email to send imperative documentation and communication to? *
What is the best phone number to reach you? *
What is your place of Residence? (We are licensed to provide Clinical services to residents in DC, Maryland and Virginia). *
Healing Her provides free 15 minute discovery calls. This is optional. Would you like a discovery call?  *
Taking this step is not easy and we understand the mixed emotions that can come with seeking therapy. We want to assure you that this is a safe place and that we are passionate about walking with you on your journey. If there is anything you would like us to know in advance, please share below.  *
My services will be covered by: *
How did you hear about us? *
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