K&B Therapy, Inc: Contact Form
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Welcome to K&B Therapy, Inc!
Legal Name (First and Last) *
Pronoun(s) *
Phone Number *
Email *
Date of Birth *
Preferred Language *
Service of Interest *
Are you able to pay for services? *
Which one of the following insurance panels that we accept, do you have? *
If Applicable, please specify your Insurance, if you plan to utilize your Out of Network (OON) Benefits and are requesting a Super-bill
Please note: Not all of our clinicians accept all insurance plans listed above. Please Click here to learn which clinician(s) at K&B Therapy, Inc are in-network providers for your insurance. 
Preferred Clinician for Service(s) *
How committed are you to therapy at this point in time? Rate yourself on a scale of 1(I am unsure if therapy is something I want right now) to 10 (I am seriously committed)
Reason(s) for seeking service(s) *
Specify day(s)/time(s) you are available for service(s). *
I am currently residing in the State of California *
Best day(s)/time(s) for a free 15 minute phone consultation *
Referred By: *
Please Note
*Our office will contact you via email/phone to confirm your free 15 minute phone consultation
**Please check your junk/spam folder, as sometimes our office's emails are classified as spam by some internet email providers.
***K&B Therapy, Inc's clinicians are unable to provide telehealth/virtual services for client(s) residing outside of the State of California.
****Please note not all of our clinicians are paneled with all/any insurance panels. Please verify
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