Request an Appointment
The quickest way to get started is to complete the encrypted form below. Please note that availability fluctuates and submitting this form does not guarantee an appointment. We will respond within 48 business hours.
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Full Name *
What name do you go by and what are your pronouns?
Your date of birth *
Email address *
Aviva standardly emails benefits and scheduling information. We use secure email to send these messages from our end. However, we cannot guarantee the confidentiality of content in a conventional (i.e. regular Gmail) inbox. Aviva can also send encrypted emails, which will require you to log onto a portal to receive communications. Please choose your email communication preferences: *
Phone number
May we leave a message at this number?
How did you hear about us?
What health insurance company do you have? (Blue Cross, Tufts, Aetna, Cigna, etc.)
What is your Member ID / Subscriber Number? (typically located on the front of your card)
Do you have secondary insurance (another policy with the same or different company that also provides health coverage)?
Clear selection
We offer in-person and teletherapy services, depending on availability. Which are you interested in? Check all that apply. *
Which services are you interested in? Check all that apply.
Briefly describe the reason you are seeking services: *
What days and times are you regularly available to participate in hourly sessions?
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This form was created inside of ABK Counseling & Wellness, LLC.