Contact Form
The Woolf Center New Client Form
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First and Last Name *
Phone Number *
Email Address *
Are you looking for Teens, Individuals, or Couples Therapy? *
Required
What is your presenting concern? *
What insurance do you have? 
*We are NOT currently in-network; we are collecting this information for future reference*
 *
State of Residence (Example: Maryland) *
I understand The Woolf Center does not participate with insurance companies (with the exception of Aetna), they are an out of network self-pay service provider. The Woolf Center can provide a superbill (receipt) for possible out-of-network reimbursement benefits.
 *
Required
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This form was created inside of Elana Woolf Therapy.