Contact Form

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Contact Form

The Woolf Center New Client Form

First and Last Name *

Phone Number *

Email Address *

Are you looking for Teens, Individuals, or Couples Therapy? *

Teens

Individual

Couples

Family

Coaching

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 Victoria Davis accepting Aetna). The Woolf Center can provide a superbill (receipt) for possible out-of-network reimbursement benefits.
*

Yes, I want to submit this form & agree to the terms of use.

Required

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This form was created inside of Elana Woolf Therapy.