Thank you for reaching out! If you would like to become a new client at Beehive and have not done so already, please fill out the form below. 

Beehive's Main Directory: 860-281-1133
Call or text Beehive at 860-325-2929
Email: hello@beehivecw.com
Fax: 860-650-0655

If you are a client and you need to reach your therapist, please call or text them using the number on their webpage: www.beehivecw.com or call 860-281-1133.
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Client's first and last name *
Caretaker/Parent/Guardian's name (Skip if client is an adult/does not have a caretaker/guardian) 
Birthday *
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YYYY
Telephone number (123-456-7890) *
Email address *
How would you like us to contact you? *
Required
How did you find us?
Please write a few sentences about what you're seeking in therapy, this will help us match you with a therapist. If you were referred, please mention that here.  *
Would you prefer to be seen in person or over video? *
What is your availability?  *
If you have a specific therapist in mind, please write in their name under "other"
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Which insurance do you have? *
Required
What is your insurance member ID?
Have you seen or are you currently seeing another mental health provider? If yes, please choose other and list their name and the length of time that you were seen. *
Have you been hospitalized due to mental health in the past year? If yes, please choose other and provide some details.  *
Are you currently involved in a legal case (criminal, workers' compensation, disability, accident/injury, DCF)? If yes, please choose other and provide some details.  *
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