The Mental Health Club Send Message

Who would be receiving care?

Your info

For insurance verification
Select the state you live in
She/her, He/him, They/them, She/they, He/they
Reason for care
Please tell us briefly why you're here and perhaps what you hope to accomplish with therapy.
Limited to 600 characters
Please tell us approximately how long you've been experiencing these concerns.
If so, please explain the impact on sleep and/or appetite.
Check all that apply
For example: what you'd like to focus on, a recent triggering life event, stressor, or loss, etc.
Limited to 600 characters
If so please share.
Administrative
Please share how you were referred to us
Billing & Payment
The Mental Health Club is currently Self-Pay Only / Out-of-Network. We accept payment at the time of service and can provide or submit a superbill on your behalf for out-of-network insurance reimbursement. Are you comfortable with this arrangement?
We can help you get an insurance reimbursement estimate from your insurer.
Our standard rate for individual therapy is $275 per session (45 min); Our standard rate for couples therapy is $325 per session (60 min). We also offer sliding scale options when needed. How would you like to proceed?
Client Preferences
If you're hoping to find a therapist who is trained in a particular modality, we'd love to know this! It's not necessary, however, for this to be part of your criteria.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.