New Client Inquiry
Thank you for your interest in Looking Glass Counseling. We provide individual therapy for adults ages 18+. We currently have a waitlist for new clients, and the wait times can fluctuate. Typically, the wait time is 1-5 months for daytime appointments and 6-12 months for early mornings, evenings, weekends, and specialty appointments. To determine availability, please provide the information below. If you're interested in a group, please visit our Support Groups page.

We currently have a short waiting list for daytime openings for telehealth with a male therapist or in-person sessions in our Medford Square office. The telehealth openings are for clients with the following insurance plans: BCBS, Harvard Pilgrim, Cigna, Aetna, United & AllWays. And the in-person openings are for clients with Cigna, Aetna, United & AllWays.
Sign in to Google to save your progress. Learn more
Name: *
Email: *
Phone number: *
Age: *
Please indicate your insurance provider: *
How did you hear about us? *
Briefly, what would you like to focus on in therapy? *
If you are looking for a therapist who specializes in a specific area, please note:
Please indicate any preferences you have in terms of the therapist you would like to work with:
Our hours are 8:00 am to 9:00 pm Monday through Friday, and we have a small number of weekend hours as well. What days and times are you available for sessions? Please be specific: *
Are you interested in joining a support group? If so, what topics would you be interested in?
Would you be willing to work with a Master's level intern for an out-of-pocket fee of $40 per session? This would not go through your insurance. *
Which appointment type do you prefer?  *
Please note that the information you provide will be kept confidential and only used for purposes of determining the right form of therapy/therapist for you. Looking Glass Counseling takes privacy seriously and does not share or sell personal information.
Thank you for your interest. We will reach out via email when there's an opening that suits your schedule, insurance, and preferences.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pen and Press. Report Abuse