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Transform and Thrive MFT Collective Therapy Inquiry Form

This form is secure and HIPAA‑compliant. Please use it to share basic contact information and general inquiries. By completing this form, you are taking the first step toward reaching out for support. We will follow up directly by phone or from our official Transform and Thrive MFT email (ending in @transformandthrivemft.com) to set a time to connect. 

Please do not include detailed health information here, as those details will be discussed safely during direct communication. Inquiries are typically answered within 2–3 business days and are not monitored during evenings or weekends.

This form is not intended for urgent or emergency situations. If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or dial 911 immediately.

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First Name *
Last Name *
Email Address *
Phone Number *
Date of Birth *
MM
/
DD
/
YYYY
What is your preferred method of contact? **Please check your voicemail, text messages, and email spam/junk folders for our reply to ensure you don’t miss our response.** *
What type of therapy are you seeking? *
Required
Please briefly describe the main reason you are seeking therapy at this time. *
Have you been in therapy before?
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How do you plan to pay for sessions? *

What is the name of your insurance company/provider? 

Description: (e.g., Aetna, United Behavioral Health, Optum. If you are Self-Pay/Private Pay, please type "N/A").

 *

If known, what is your behavioral health member ID number? 

Description: (If you are Self-Pay/Private Pay, please type "N/A").

 *
How would you rate the urgency of needing an appointment? *
Low Urgency
High Urgency
What days/times are you generally available for appointments? *
Morning (9am-12pm)
Afternoon (12pm-4pm)
Evening (4pm-7pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Do you have a preferred therapist you would like to work with? Leave blank if you have no preference. Please note: Matching depends on current availability, scheduling, and clinical fit. If your preferred clinician is currently full, we will discuss other excellent options within our collective. *
How did you hear about us? *
Required
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