Name *

First Name

Last Name

Phone *

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Type of Counseling

Individual Adult Counseling

Couples Counseling

Family Counseling

Adolescent Counseling (14-17)

Preteen Counseling (10-13)

Child Therapy (3-9)

Area of Focus

Trauma

Depression

Anxiety

OCD

Mood Disorders

Boundaries

Communication Skills

Relationship Skills

Chronic Illness/ Pain

Terminal Illness

Self-Esteem

ADD/ADHD

Grief

Addiction

Availability

Morning 8 AM-12 PM

Afternoon 12 PM-4 PM

Evenings 4 PM-6 PM

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

Appointment Preference

In Office

Telehealth

Both

Payment Preference

We encourage you to call your insurance provider for your in network mental health coverage information. This includes whether or not you have met your deductible, if you have a copay or coinsurance. For private pay sessions, we can provide a superbill for you to file with your insurance as out of network for a potential reimbursement.

Blue Cross Blue Shield Insurance

Private Pay

Optum: United Healthcare Insurance & UMR

Aetna

Counselor Preference

Elizabeth DeVargas

Tracy Bijeaux

Emilia Ranzino

Charlotte Bienvenu

Jackie Hidalgo

Abby Webb

Gabby Sonnier

Genevieve Ingraldi

Rae Guidry

Mollee Helmick

Heidi Nowicki

Hannah Hopkins