New Client  Interest form
Please complete the following information, you will be contacted within 48 hours via email.

*Clients must be based in NYS or Florida during scheduled appointments.

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Email *
Thank you for your interest!
I am  in-network with Cigna, Aetna, BCBS- Excellus, Humana, and UMR for Mount Sinai Employees. I also offer self-pay services. Not in-network with Medicaid/Medicare plans at this time.
Please complete this form and expect instructions to schedule your first appointment!

First/Last Name *
Date of Birth *
Do you agree to be contacted via email by this practice? *
Can we leave a voice message? *
State of Residence *
Please provide address. *
Phone number *
Please briefly share your presenting concerns: *
Are you interested in Online Counseling? *
What are your pronouns?
Do you identify as Black, indigenous, Hispanic, or person of color?
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Are you covered under any health insurance plans, if so, what plan?

How did you learn about Alexis James Virtual Counseling? *
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