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Antenucci Therapy Group
Therapy Interest Form
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Email
*
Your email
Name
Your answer
Phone
Your answer
Date of Birth
Your answer
Therapist Preference
Emily Winslow
Amanda Antenucci - Waitlist Only
Either
Mode of Treatment
Telehealth in Oregon
Telehealth in Washington (with Amanda)
In person in SW Portland (with Amanda)
Hybrid in person and online
Payment
Out of Pocket/Out of Network
Insurance reimbursement through Kaiser
Insurance reimbursement through MODA
Insurance reimbursement through Pacific Source
Which of the following are you seeking from therapy
EMDR
Processing past trauma
Anxiety management
Mindfulness
LGBTQIA+ supportive care
What brings you to therapy at this time? Is there something specific, such as a particular event?
Your answer
Is there anything else you'd like us to know?
Your answer
This information shared in this form is for inquiry purposes only and does not guarantee a treatment relationship.
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