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Soul Sprout Mindful Care, Inc
Please use this form to request an appointment with a clinician who is able to accept your insurance!
Frequently Asked Questions:
If your insurance is not listed below, we are unable to accept it. We are also unable to accept marketplace versions of these health plans.
If your state is not listed below, we do not have clinicians that can serve you. Your clinician must be licensed in the state you will be physically in during the therapy session, which may be different from your state of residency.
If you are requesting more then one type of therapy, please complete this form more then one time.
Due to the telehealth nature of our service, we are unable to serve children under 7 years of age at this time.
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First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
State (the state you will be in when therapy is taking place)(please note, we are only able to provide services to you if your state is listed below!)
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Choose
Florida
Georgia
Massachusetts
South Carolina
Vermont
Type of Therapy Needed (If you are in need of multiple types of therapy, please complete a new request form for each type of therapy)
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Choose
Adult Individual Therapy - (Ages 18+)
Adolescent Individual Therapy - (Ages 12-18)
Children's Individual Therapy - (Ages 7-12)
Couples Therapy
Family Therapy
Insurance
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Choose
Blue Cross Blue Shield
Aetna
Optum
The Alliance
MGBHP/AllWays
United Behavioral Health
United Health Care
I plan to pay out of pocket.
Mental Health Concerns - What brings you into therapy?
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Your answer
How did you hear about us?
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Psychology Today
Therapy for Black Men
Therapy for Black Girls
Thriving Campus
Google
Insurance Directory
Other:
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