Starting Therapy Please fill out this form and Danielle will reach out to schedule your free 15 minute phone consultation! Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Daily Availability - check all that apply * Monday Tuesday Wednesday Thursday Friday Time Availability - check all that apply * Morning (8am-10am) Late morning (10am-12pm) Mid-day (12pm-2pm) Afternoon (2pm-5pm) Location In-Person (Rittenhouse Square) Virtual (must be located in PA, NJ, or FL) Open to either! Type of Therapy Individual Therapy Couples Therapy Family Therapy Please tell me a little bit about what you're looking to get out of therapy: * Insurance Disclaimer Clicking this confirms that you understand that I am not in network with any insurance providers. If you wish to get reimbursed, I can work with you to help you submit out-of-network super bills. I accept HSA or FSA cards in addition to all other forms of payment. Thank you! You can expect an email from Danielle within the next business day :)
