Let's Connect
Tell us a little about yourself and why you are here. 
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First Name (Legal First Name) *
Last Name (Legal Last Name) *
Preferred Name
Date of Birth *
MM
/
DD
/
YYYY
Pronouns
Email *
Phone Number *
What is your preferred contact method? *
Insurance Company
Insurance Member/Subscriber ID Number
This number is located on your insurance card, usually labeled as Member ID or Subscriber Number. You can use these example cards as a reference to find your number. For MassHealth insurance cards, the number appears under your name.
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Brief reason for seeking counseling *
Do you have a preference of the gender of your counselor? *
Our counselors meet clients in person, and also via telehealth (video conferencing), please let us know what you would prefer (choose all that apply). *
Required
Our counselors also have the ability to include topics of spirituality in session. It is not required, but would you like to include spirituality in your counseling experience? *
Please let us know what days and times work best for your schedule. This will help us match you with a counselor that has availability on their schedule. 
Morining (8 AM - 12 noon)
Afternoon (12 noon to 5 PM)
Evening (After 5 PM)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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