Prescreening + Waitlist Form
Welcome—and thank you for being here. Reaching out to a therapist is a meaningful and often vulnerable step. I want to honor the courage it takes to begin this process, and I’m truly glad you’ve found your way here. This form helps us determine whether we might be a good fit in terms of both your needs and current availability. 

I have current availability for self-pay clients. My insurance-based slots are currently full. Due to the nature of therapy, it's difficult to provide an accurate estimate of when availability will open again. That said, filling out this form will constitute being added to my waitlist. I appreciate your understanding and flexibility with this process!

If you run into any questions or need support while filling out the form, feel free to reach out: lori@lorizaspel.com. 

If you are in crisis and need immediate and emergency assistance please call 911, go to the nearest emergency room, or contact the Suicide Lifeline at 988. A list of non-carceral crisis supports is available here.
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Email *
Your name: *
Your pronouns and/or any gender identity you'd like to share:
What is the best phone number to reach you for a 15-minute consultation call? Not sure what the purpose of a consultation call is meant to be? Check out my blog post on this topic here. *
Your age (I only work with people 18+):
Do you live in Pennsylvania or Florida? I am only able to provide therapy to Pennsylvania and Florida residents at this time. Even virtually, the Client must be within PA or FL state limits! *
I have general availability 10 am-5 pm Monday through Thursday. If you would prefer evening sessions or Fridays, I am not a good fit. Are sessions during these hours something you could see working for you?
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I have availability for self-pay clients at this time. If that's you, which of the following session times and cadences would work best for you?
How will you be covering the cost of your therapy sessions? Please note I am not accepting new insurance-based clients at this time. Your information here will constitute being added to my waitlist. For self-pay, my sliding scale is available here. If you're curious about why someone might self-pay for therapy, or if that is new to you, I wrote a blog about that here.
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What concerns / modalities are you interested in working with in therapy at this time? Click as many as apply. *
Required
Please briefly describe what has brought you to therapy at this time:
What are your top three ideas about or goals for therapy?
Please indicate if any of the following are a current concern for you:
Yes
In recovery, 5+ years
In recovery, less than 5 years
No, never a concern
Unsure
Substance use or misuse
Disordered eating
Have you been in therapy before or are you currently?
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What about my website/profile led you to reach out to me specifically?
Is there anything else I should know that would help support you in therapy?
How did you hear about my therapy practice?
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Please check to indicate understanding of the following: *
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