Integrative Empowerment Group, PLLC Appointment Request

At this time, we are at capacity and accepting all new potential clients onto our waitlist.  Generally, you can measure wait times in months, but time on our waitlist varies greatly, depending on availability, location, insurance provider, special requests, and other factors.

We have been experiencing significantly shorter waits for new clients with BCBS, BCC, and cash payment.

We have been experiencing significantly longer waits for new clients with BCN, Aetna, and MCare.

This is due to insurance compatibility with available clinicians.

To join the waitlist, we will gather information below and email you to confirm contact and insurance/payment preferences. Our referral coordinator draws from the top of the waitlist and will connect you with a compatible clinician that shares your availability and interests. That clinician will contact you directly via email with paperwork to complete, some more general information, and to schedule your first appointment. 

Thank you for your interest in IEG!

This Google form is HIPAA compliant and confidential.


Name (first and last) *
Legal Name (if different)
I am seeking therapy for myself at this time *
I am 18 years or older.
*
Email *
Is it okay to email you? *
What is your phone number? *Note our primary mode of communication is email. *
Is it okay to contact you by phone?  Select all that apply. *
Required
We accept the following insurances. Additionally, clients can pay for services out of pocket, including at a sliding scale rate. Please select from the following. *
Required
Which methods of therapy are you open to at this time?  (select as many as apply)

Notes*
-Per licensing regulations, teletherapy is only available to folx located in Michigan. 
-In-person sessions are held at 124 Pearl Street in Ypsilanti, Michigan, one block from the Ypsi Transit Center.
*
Required
What is your availability Monday - Sunday 8am-10pm? Please include days and time blocks (e.g. Mondays from 11-3). *
In a few words, tell us what would you like to work on in therapy? *
Are there any identities you hold that you would like us to consider when connecting you with a therapist?  (**Please note that we will use this information to make the best match possible, however we can not guarantee placement based on the responses to this question.) 
Are there qualities/identities in a therapist that are important to you? (**Please note that we will use this information to make the best match possible, however we can not guarantee placement based on the responses to this question.)  
Please describe your accessibility needs. Note our office is ADA compliant.
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