Clinical Service Request
This form is for anyone who has reviewed my website |
| and believes it might be a good fit for us to work together, who wants to discuss treatment options or potentially schedule a brief phone consult.
***11/19/21 UPDATE: The majority of my caseload is reduced cost, sliding scale, and/or free services. I have several private pay openings remaining. If hoping to use insurance benefits, can do out-of-network reimbursement only (Note: I DO NOT have current openings for BCBSRI or BCBSPPO plans).
Treatment costs are based on an economic justice, tiered model, in that those who pay my standard rate help to support those who would not be able to access care without a reduced fee.
[Please review my fee model & current rates:
If my rates are inaccessible, if I'm not accepting new clients with your insurance, and/or if you don't have out-of-network coverage, please consider the following additional options:
1) Add your email to my newsletter for practice & availability updates (
2) Sign up for a group or workshop, which are lower cost:
3) Page with referral information here:
WHOLEHEARTED PSYCH | Dr. m. addyson tucker (they/them) - Licensed Psychologist in RI & MA
[Anti-racist & Gender Affirming - Trans, Black, & Fat Liberation focused]
Questions about my practice or this form? Email:
***NOT for any sensitive information that requires an immediate or urgent response.
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Did you read the ***UPDATE in the intro paragraph above about my current availability?
Yes - I am able to pay the standard/full fee.
Yes - I am able to pay the standard/full fee, but only if less frequent or shorter length appointments are indicated for me.
Yes - I'd like to schedule a consultation session to discuss referral options & other potentially helpful resources.
Yes - I am interested in short-term, focused counseling services rather than long-term - can we talk more about that?
Yes - I'm seeking a gender affirming surgery assessment, not counseling (go to
Yes - I look forward to hearing when/if things open up. [Please see below for potential groups/workshops you might be interested in.]
*VERIFICATION: How cute are these pups on a scale from 10 to 10?
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