Intake Screener - Anxiety Therapy LA
Best phone number to reach you or client
Spouse or Partner
Name of client if not calling for self
Preferred office location
This is for after the shelter in place is lifted and it's safe to go into the office.
Trichotillomania (hair pulling)
Dermatillomania (Skin picking)
Body Dysmorphic Disorder
Generalized Anxiety Disorder
Panic disorder/Panic Attacks
Autism co-morbid with one of the above
Primarily interested in:
Please note at this time we are only providing online therapy until it is safe to meet in person.
Individual therapy in person (Please note that due to Coronavirus, we are only meeting with clients via teletherapy at this time)
Individual therapy online (Please note we are only licensed in CA and can only provide teletherapy in CA)
We have 5 therapists who work at Anxiety Therapy LA. For more information about our therapists please see
Preferred day of the week (Check all that apply)
Preferred time of day (Check all that apply)
Depends on the day
How did you hear about us?
TLC for BFRBs
Other Online location
Please note, we are out of network with all insurance companies. We can provide a superbill for you to get reimbursement from your insurance company. Payment is required at time of treatment.
I allow Anxiety Therapy LA to contact me via email or phone to connect about possible treatment. We will respond within 48 hours. Please make sure to check your spam folder if you have not heard from us.
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