Yolo Therapy Consultation Request
Thank you for contacting Yolo Therapy, LLC for all of your therapy needs. At Yolo Therapy, we believe everyone is entitled to effective mental health treatment regardless of barriers and limitations. Our goal is to provide services to as many people as possible while also protecting the sanctity of therapy. At this time, we currently have very limited availability and are only able to accept clients on a case-by-case basis. While we cannot guarantee immediate appointments, we invite you to complete this form so that your information can be reviewed. As openings become available, we will be happy to contact you to further assess your therapeutic needs at that time.

Thank you for your understanding and we look forward to working with you!
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Email *
First and Last Name
Date of Birth *
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Phone number *
Please enter a number that can receive SMS messages
Which area do you live in? *
What type of service are you interested in? *
Please select all that apply.
Required
When would you like to schedule an initial consultation appointment? *
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What are some of the concerns you would like to address in therapy? *
Have you ever participated in therapy before? *
Please select the best day(s) for scheduling appointments. *
Please note that scheduling preference is subject to availability.
Required
Please select the best time of day for appointments. *
Please note that scheduling preference is subject to availability.
Required
Preferred Clinician *
How did you hear about us? *
As a practice, we only accept self-pay clients. By submitting this consultation request, you are acknowledging that you intend to pay for services out-of-pocket. If you have confirmed the availability of and intend to utilize out-of-network (OON) benefits through your insurance provider, please let us know as we can provide you with the necessary documentation. *
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