New Client Inquiry

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New Client Inquiry

Thank you for your interest in Looking Glass Counseling. This form is for individual therapy only.

We currently have immediate openings for daytime sessions, both for telehealth and in-person sessions in our Medford Square office. There is a wait for in-person sessions in our Davis Square office. Typically, the wait time is 0-3 months for daytime appointments and 3-9 months for early mornings, evenings, and specialty appointments.

If you're interested in a group, please visit our Support Groups page. If you are interested in couples therapy, please fill out our couples therapy inquiry form.

Name: *

Email: *

Phone number: *

Age: (we only work with adults 18+) *

Please indicate your insurance provider:

Note that we do not take Mass Health plans, or Tufts Direct or Tufts Together plans.

How did you hear about us? *

Briefly, what would you like to focus on in therapy?

(reminder that couples therapy inquiries fill out this form instead)

If you are looking for a therapist who specializes in a specific area, please note:

Please indicate any preferences you have in terms of the therapist you would like to work with:

Our hours are 8:00 am to 8:00 pm Monday through Thursday, 8:00am to 4:00pm on Fridays. We are not offering weekend sessions at this time. Sessions from 10am-3pm Mon-Thurs tend to have a much shorter wait time. What days and times are you available for sessions? Please be specific: *

Are you interested in joining a support group? If so, what topics would you be interested in?

Would you be willing to work with a Master's level intern? We accept Aetna, Cigna, United, Tufts and Harvard Pilgrim insurance for this. Or we offer a generous sliding scale if you have other insurance. *

Yes

Maybe

Which appointment type do you prefer? Please note that we require weekly sessions up front. *

In-person, Somerville location only

In-person, Medford location only

In-person, either location

Telehealth only

Telehealth or in-person at Somerville

Telehealth or in-person in Medford

No preference

PRIVACY NOTICE

Please note that the information you provide will be kept confidential and only used for purposes of determining the right form of therapy/therapist for you. Looking Glass Counseling takes privacy seriously and does not share or sell personal information.

Thank you for your interest. We will reach out via email when there's an opening that suits your schedule, insurance, and preferences.

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