Please describe reason(s) for seeking therapy as this will help us to connect you with the best fit therapist. *
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List therapist preference. Please write in "any" if you are open to a referral regardless of whether your top choice(s) has availability.
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Please list daytime availability M-F. Please note that evening slots fill quickly and tend to stay full. *
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Name of Insurance Company (If you would like to get a head start on the next step, please email your insurance card and your date of birth to info@cottageat933.com) *