Therapy Waitlist
Thank you for your interest in working with Dr. Karissa Burnett for psychotherapy (weekly telehealth sessions, clients must be physically-located in MA, CA, or WA). Her caseload is currently full and she regrets that she cannot be of more help, but please complete this brief form if you would like to be added to her waitlist. Anticipated wait-times can be found in the "Practice Forecast" on the bottom of the Home page, and therapy referral recommendations are on the Resources page.

Dr. Burnett's waitlist is non-binding, meaning that she will reach out to you via email if/when she has an opening, but you are not obligated to start working with her until after you formally-decide to begin treatment and complete intake paperwork. You will have the opportunity to ask her questions to assess fit before making this decision.

Potential clients are typically contacted in the order their requests were received, but may be prioritized based on goodness of fit, which is the most important factor in effective therapy. Unfortunately, Dr. Burnett cannot guarantee that you will become her therapy client. You are encouraged to reach out to other therapists to get the support you deserve ASAP.

NOTE: The data you provide on this form does not constitute a therapeutic relationship with Dr. Burnett. Although this form is stored on a secure server, please try to use general themes when providing any healthcare information rather than specific details about your history (e.g., "late-diagnosed autistic," "trauma survivor," "history of being gaslighted," "hoping to override internalized ableism").

If you decide to select "send me a copy of my responses" once the form is complete, the electronic transmission of this form to your email account is not guaranteed to be secure. Submitting your form without receiving a copy is recommended to ensure your privacy. 
 
This form is not to be used in times of crisis. Please call 911 or visit a local hospital for emergency services. See the Resources page for non-emergency support ideas.

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Email *
Phone Number
First & Last Name *
Pronouns
How old are you? (*Dr. Burnett works with adults) *
Which state do you expect to be physically-located in for telehealth therapy sessions? (*must be a state Dr. Burnett is licensed in) *
Do you anticipate having access to a private location with solid Internet & equipment for telehealth sessions (e.g., webcam, mic)? *
Describe your goals for therapy and why Dr. Burnett seems to be a good fit: *
Please indicate whether you have been formally-diagnosed with a neurodevelopmental difference (e.g., autism, ADHD, dyslexia). If not, do you self-ID, and would you be seeking a formal diagnosis through your work with Dr. Burnett? (*not required, but testing may be recommended first depending on documentation/access needs). 
Do you understand that Dr. Burnett is an out-of-network provider who does not work directly with insurance companies? (*payments are due at time of service, see Fees page for current rates, although they are subject to change) *
How did you find out about Dr. Burnett's services? (e.g., Google, Neuroclastic, Psychology Today, Therapy Den)
If you are located in MA, would you like to be notified when Dr. Burnett hires other neurodiversity-affirming therapists with more availability?
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