Appointment Request Form

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Email *

Your name

Your Phone Number

Which service(s) are you seeking? (check all that apply)

Individual therapy for an adult

Individual therapy for a child or teenager

Assessment, testing, or evaluation services

Neurofeedback

Family therapy

Couples or relationship counseling

Parenting support and/or co-parenting support (coaching/consultation)

Single session (one meeting, online)

Groups: social groups, RPG groups, games groups, discussion groups, therapy groups, parent groups, other groups

Consultation on neurodiversity, neuro-differences, autism, ADHD, gifted/2e, academics, education, IEP, homeschooling, management support in the work place

Clinical Supervision

Speaking engagements

Minecraft: I would like to get whitelisted to play on TheraThrive's Minecraft server (TheraThriveMC)

Other:

Age of client(s)

4 years old or younger

5-11 years old

12-17 years old

18 years old or older

If the client is under age 18, do all legal parents/guardians give consent?

Yes

Other:

Clear selection

Please indicate your meeting location preference

Lafayette Office

Burbank Office (Toluca Lake/LA Area)

Online (video conference)

Other:

Days you can schedule (days indicated below are in the Pacific Time Zone, please adjust if you are in a different time zone or write in under "other")

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

I'm flexible

Other:

Times you can schedule (times indicated below are Pacific Time, please adjust if you are in a different time zone or write in under "other")

8am-12pm

12pm-4pm

3:30pm and after

I'm flexible!

Other:

Please briefly describe what you are seeking help for, and/or share information that would be helpful for us to know.

Preferred Therapist

For information about our professionals, visit: https://www.therathrive.com/about/professionals

Michael Sacco, APCC, Senior Associate Therapist, has current openings, Toluca Lake/Burbank office and online, $215 per 45-50 minute individual therapy session (group fee $57/hr)

Arielle Rabby-Chia, LMFT, APCC, Licensed Therapist, Senior Associate Therapist, Associate Assessor, has current openings for therapy and assessment clients, Toluca Lake/Burbank office and online, $215 per 45-50 minute per individual therapy session (assessment fees vary; group fee $57/hr)

Heather Hanford, AMFT, Associate Therapist, has current openings, Toluca Lake/Burbank office and online, $195 per 45-50 minute individual therapy session (group fee $57/hr)

Alissa Cohen, LPCC, Credentialed School Psychologist, Licensed Therapist and Assessor, has current openings for therapy clients, has current openings for child and teen assessment, Toluca Lake/Burbank office and online, $229 per 45-50 minute per individual therapy session (assessment fees vary; group fee $57/hr)

Hilary Litterick, AMFT, Senior Associate Therapist, has limited openings, Lafayette office and online, $215 per 45-50 minute individual therapy session (group fee $57/hr)

Lydia Wang Koerner, AMFT: Senior Associate Therapist, has limited openings, Lafayette office and online, $215 per 45-50 minute individual therapy session (group fee $57/hr)

Katie Malone, LPCC, LMFT, Clinical Director, current openings for assessments, limited availability for consultation and new therapy clients, Lafayette office and online, $300 per 45-50 minute therapy/consultation session (assessment fees vary)

Grace Malonai, PhD, LPCC, Executive Director, current openings for assessment, limited availability for consultation and new therapy clients, Lafayette office or online, $300 per 45-50 minute therapy/consultation session (assessment fees vary)

First available appointment

Do you reside in the state of California? (for online/telemental health)

Yes

Other:

Clear selection

If not California, which state, province and/or country do you reside in?

CAPTCHA

6+2= *

Thank you!

We sincerely appreciate your taking the time to reach out, and look forward to connecting soon.

Please tap the SUBMIT button to send us your request. Thank you!

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