Truckee Therapy Appointment Request
Please use this form to get started.  Give us a call at (530) 285-3335 if you have any questions, or for a faster response, email us at truckeetherapy@gmail.com.  Once your form is submitted, someone from our team will reach out to you within 48 hours.  Thank you!
Sign in to Google to save your progress. Learn more
Full Name *
Date of birth *
MM
/
DD
/
YYYY
Email Address *
Phone Number *
Billing *
Insurance type and ID number (Blue Shield of CA and County Medi-cal are NOT accepted at this time).  Acceptable options include Anthem, Anthem Medi-cal, Blue Shield Federal or Out of State Plans, UMR, United Healthcare, Optum, Hometown Health, Multiplan...
Preferred Therapist (okay to pick more than one)
Location Preference
Reason for seeking therapy
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy