SentiMental Health Virtual Psychotherapy Inquiry

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Please fill out the google form below and we will reach out to you within 48 hours to discuss options and availability.

I am inquiring about *

Myself

My child

How do you prefer to be contacted? *

Phone

First & Last Name (If for your child, please provide your name and their name)

Date of Birth of client *

YYYY

Contact Information (Email + phone number) *

Reason for seeking services *

Relationship troubles

Depression

Trauma

Anxious Distress

Looking for a Diagnostic Eval

Personality Disorder

Autism

ADHD

Looking for Play Therapy for my child

Dissociation

Other:

Required

SentiMental Health is presently working on getting credentialed with insurance. If you have one of the insurances below, please select. We will notify you a time estimate of when we will be credentialed.

If you do not have insurance OR you are wanting to get started right away, SentiMental Health offers private pay sessions for 70 dollars (unless a sliding scale has already been discussed).

If services are for a minor, are there any parent custody arrangement legal documents? Please note, if so BOTH parents will need to be in agreement and BOTH parents will need to complete paperwork for services to be provided.
*

Yes, there are parent custody arrangement legal documents. I understand that both parents will need to be in agreement and both parents will need to complete paperwork for services to be provided.

No, there are no parent custody arrangement legal documents in place at this time.

N/A

Please provide good time to contact you. *

Please provide any information that you would like your future therapist to know.

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