Request an Appointment
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Request an Appointment
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Potential Client Name
*
First
Last
Date of Birth
*
Please verify that this date is correct before moving to the next item. Make sure to change the year from 2022
Is the client a minor?
*
Please Choose
No
Yes
How open is the youth to receiving therapy?
Selected Value:
1
Share their rating of possible engagement and motivation for therapy.
Caregiver Name
*
First
Last
Email
*
Phone
*
Upload picture of State ID / Drivers License for the person responsible for payment
Click or drag a file to this area to upload.
Method of Payment
*
Please select choice.
(Private Pay) Cash
Aetna
Allways Health
Auxiant
Beacon Commercial
BeneMax
Blue Cross Blue Shield Insurance
BMCHP
Cigna
EAP (from ANY Insurance)
Fallon Health
Harvard Pilgrim Insurance
Health Plans Inc
Masshealth BMC Healthnet Plan
Masshealth MBHP
Masshealth Steward
Masshealth Tufts Public Health
Tufts Commercial
Unicare
United Behavioral Health
United Healthcare
Insurance # / Member ID / Masshealth #
*
EAP Services requested already?
*
Please select choice.
No
Yes
The EAP benefits you use before accessing your insurance. In order to use the services the right way, you must request the authorization before starting treatment. Have you done this already? If no, we can give instructions on how to do this.
EAP Authorization Number
*
To use your EAP benefit you will have to ask for an authorization. Please provide that authorization here.
Upload Picture of Insurance card
Click or drag a file to this area to upload.
Is the client covered by any additional insurances?
*
Yes
No
What's the second Insurance?
*
Please select choice.
Aetna
Allways Health
Auxiant
Beacon Commercial
BeneMax
Blue Cross Blue Shield Insurance
BMCHP
Cigna
EAP
Fallon Health
Harvard Pilgrim Insurance
Health Plans Inc
Masshealth BMC Healthnet Plan
Masshealth MBHP
Masshealth Steward
Masshealth Tufts Public Health
Tufts Commercial
Unicare
United Behavioral Health
United Healthcare
Insurance # / Member ID / Masshealth # (copy)
*
Insurance 2 Picture
Click or drag a file to this area to upload.
Which GENNEW Location is closest to your home address?
*
Dedham, Massachusetts
Lincoln, Rhode Island
To better assign you to a clinician.
Clinician Preference
*
No Preference First Available clinician (Fastest) ANY Clinician
First Available Female (no racial preference)
First Available Male (no racial preference)
First Available Clinician of Color (non-white, no gender preference (M/F)
Black Clinician no gender preference (M/F)
Black Female Clinician
Black Male Clinician
LatinX Clinician no gender preference (M/F)
LatinX Female Clinician
LatinX Male Clinician
Selecting any option that mentions no preference will always be the fastest way to get assigned. Please also understand that No gender preference means male or female therapist assigned. And clinician of color means any non-white clinician.
Service delivery preference
*
(Fastest) - First available in person or Telehealth assignment (no preference)
In Person Only - (Face to Face)
Telehealth Only - (Remote Therapy) (Faster)
Please know that we have different providers for different services. Due to the pandemic the in person services are very limited while telehealth options are more flexible and expansive at the moment.
What (No Preference) services are you seeking?
*
Select Service
(No Preference) Couples Therapy
(No Preference) Family Therapy
(No Preference) Group Therapy
(No Preference) Individual Therapy
(No Preference) Licensure Supervision
These sessions could be scheduled for in person or telehealth, whichever is available first.
What Telehealth services are you seeking?
*
Select Service
[Telehealth] Couples Therapy
[Telehealth] Family Therapy
[Telehealth] Individual Therapy
[Telehealth] Licensure Supervision
These sessions are only scheduled for remote telehealth sessions.
What in-person services are you seeking?
*
Select Service
[In-Person] Couples Therapy
[In-Person] Family Therapy
[In-Person] Group Therapy
[In-Person] Individual Therapy
[In-Person] Licensure Supervision
These sessions are only scheduled for in-person face to face sessions.
Partners Name
*
First
Last
Partners Cell Number
*
Partners email
*
Has the partner agreed to also participate in therapy?
*
Yes
No
What is the partners motivation level for participating in couples therapy?
Selected Value:
1
Share their rating of possible engagement and motivation for therapy.
1st Choice of No Preference Clinician (All Locations)
*
Select the Therapist you want most.
Any Clinician (Fastest Method)
Carolyn Gallagher, MSW (1 week wait)
Elliette Utset, MS (1 Week wait)
Kimberly Palmisano, (Intern) (1 week wait)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Nicholas Casali, LCSW (2 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
David Pransky, LCSW (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Hattab, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LICSW (3 Month wait)
Charles Boateng, (Intern) (3 month)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Maia Roper, LICSW (4 Months)
Tara Hagopian, LCSW (5 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of No Preference Clinician (All Locations)
*
Next best pick
Any Clinician (Fastest Method)
Carolyn Gallagher, MSW (1 week wait)
Elliette Utset, MS (1 Week wait)
Kimberly Palmisano, (Intern) (1 week wait)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Nicholas Casali, LCSW (2 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
David Pransky, LCSW (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Hattab, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LICSW (3 Month wait)
Charles Boateng, (Intern) (3 month)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Maia Roper, LICSW (4 Months)
Tara Hagopian, LCSW (5 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first one choosen.
1st Choice of Telehealth Clinician (Any) (All Locations)
*
Select the Therapist you want most.
Any Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Carolyn Gallagher, MSW (2 week wait)
Nicholas Casali, LCSW (2 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elliette Utset, MS (1 month wait)
Kendra Lisenby, MA (1 month wait)
Cindy Gonzales, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
David Pransky, LCSW (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Hattab, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LICSW (3 Month wait)
Charles Boateng, (Intern) (3 month)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Maia Roper, LICSW (4 Months)
Tara Hagopian, LCSW (5 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of Telehealth Clinician (Any) (All Locations)
*
Choose a Backup Option
Any Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Nicholas Casali, LCSW (2 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elliette Utset, MS (1 month wait)
Angel Garcia, MA (1 month wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
David Pransky, LCSW (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Charles Boateng, (Intern) (3 month)
Olivia Haskell, (Intern) (3 month wait)
Chukwudi Ugwu, MSW (3.5 months wait)
Cassandra Romkey, LCSW (4 month wait)
Maia Roper, LICSW (4 Months)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Tara Hagopian, LCSW (5 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first one choosen.
1st Choice of Telehealth Clinician (Person of Color) (All Locations)
*
Select the Therapist you want most.
Any Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elliette Utset, MS (1 month wait)
Angel Garcia, MA (1 month wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of Telehealth Clinician (Person of Color) (All Locations)
*
Choose a Backup Option
Any Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elliette Utset, MS (1 month wait)
Angel Garcia, MA (1 month wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first selection.
1st Choice of In-Person Clinician (Person of Color) (Dedham)
*
Select the Therapist you want most.
Any Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elliette Utset, MS (1 month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of In-Person Clinician (Person of Color) (Dedham)
*
Choose a Backup option
Any Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elliette Utset, MS (1 month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different clinician than the first choice.
1st Choice of In-Person Clinician (Person of Color) (Lincoln)
*
Select the Therapist you want most.
Any Clinician (Fastest Method)
Angel Garcia, MA (1 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
Sabrina Joseph, LCSW (3 month wait)
2nd Choice of In-Person Clinician (Person of Color) (Lincoln)
*
Choose a Backup option
Any Clinician (Fastest Method)
Angel Garcia, MA (1 month wait)
Partaja Spann, LCSW (2 month wait)
Cindy Gonzales, MA (2 month wait)
Sabrina Joseph, LCSW (3 month wait)
Select a different clinician from the first choice.
1st Choice of In-Person Clinician (Any)(Dedham)
*
Select the Therapist you want most.
Any In-Person Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Nicholas Casali, LCSW (2 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Janellia Jolley, (Intern) (1 month wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Charles Boateng, (Intern) (3 month)
Olivia Haskell, (Intern) (3 month wait)
Chukwudi Ugwu, MSW (3.5 months wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of In-Person Clinician (Any)(Dedham)
*
Choose a Backup Option
Any In-Person Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Nicholas Casali, LCSW (2 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Janellia Jolley, (Intern) (1 month wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Charles Boateng, (Intern) (3 month)
Olivia Haskell, (Intern) (3 month wait)
Chukwudi Ugwu, MSW (3.5 months wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first one choosen.
1st Choice of Telehealth Clinician (Any Male) (All Locations)
*
Select the Therapist you want most.
Any Male Clinician (Fastest Method)
Angel Garcia, MA (1 week)
Nicholas Casali, LCSW (2 week wait)
David Pransky, LCSW (2 month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Thaddieus Sarpy, LMHC (Unavailable)
2nd Choice of Telehealth Clinician (Any Male) (All Locations)
*
Select the Therapist you want most.
Any Male Clinician (Fastest Method)
Angel Garcia, MA (1 week)
Nicholas Casali, LCSW (2 week wait)
David Pransky, LCSW (2 month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Thaddieus Sarpy, LMHC (Unavailable)
1st Choice of In-Person Clinician (Any Male) (Dedham)
*
Select the Therapist you want most.
Any Male Clinician (Fastest Method)
Nicholas Casali, LCSW (2 week wait)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
2nd Choice of In-Person Clinician (Any Male) (Dedham)
*
Choose a Backup Option
Any Male Clinician (Fastest Method)
Nicholas Casali, LCSW (2 week wait)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (Any Male) (Lincoln)
*
Select the Therapist you want most.
Angel Garcia, MA (1 week wait)
2nd Choice of In-Person Clinician (Any Male) (Lincoln)
*
Choose a Backup Option
Angel Garcia, MA (1 week wait)
1st Choice of Telehealth Clinician (Any Female) (All Locations)
*
Select the Therapist you want most.
Any Female Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Elliette Utset, MS (1 week wait)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Partaja Spann, LCSW (3 weeks wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Elliette Utset, MS (1 months wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Cindy Gonzales, MA (2 months wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Maia Roper, LICSW (4 Months)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Tara Hagopian, LCSW (5 month wait)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of Telehealth Clinician (Any Female) (All Locations)
*
Select the Therapist you want most.
Any Female Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Elliette Utset, MS (1 week wait)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Partaja Spann, LCSW (3 weeks wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Elliette Utset, MS (1 months wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Cindy Gonzales, MA (2 months wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Maia Roper, LICSW (4 Months)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Tara Hagopian, LCSW (5 month wait)
Dr. LaTasha Sarpy, LICSW (Unavailable)
1st Choice of In-Person Clinician (Any Female) (Lincoln)
*
Select the Therapist you want most.
Any Female Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Sabrina Joseph, LCSW (3 month wait)
Maia Roper, LICSW (4 Months)
2nd Choice of In-Person Clinician (Any Female) (Lincoln)
*
Choose a Backup Option
Any Female Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Sabrina Joseph, LCSW (3 month wait)
Maia Roper, LICSW (4 Months)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (Any Female) (Dedham)
*
Select the Therapist you want most.
Any Female Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Janellia Jolley, (Intern) (1 month wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
2nd Choice of In-Person Clinician (Any Female) (Dedham)
*
Choose a Backup Option
Any Female Clinician (Fastest Method)
Jessica Furtado, (Intern) (1 week wait)
Catherine McGeough, (Intern) (1 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Janellia Jolley, (Intern) (1 month wait)
Carolyn Gallagher, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Olivia Haskell, (Intern) (3 month wait)
Cassandra Romkey, LCSW (4 month wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Select a different option than the first one chosen.
1st Choice of Telehealth Clinician (Black female) (All Locations)
*
Select the Therapist you want most.
Any Black Female Clinician (Fastest Method)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Partaja Spann, LCSW (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of Telehealth Clinician (Black female) (All Locations)
*
Choose a Backup Option
Any Black Female Clinician (Fastest Method)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Partaja Spann, LCSW (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Lorrie-Michelle Bertrand, LICSW (4 month wait)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first one.
1st Choice of In-Person Clinician (Black female) (Lincoln)
*
Select the Therapist you want most.
Any Black Female Clinician (Fastest Method)
Partaja Spann, LCSW (2.5 months wait)
Sabrina Joseph, LCSW (3 month wait)
2nd Choice of In-Person Clinician (Black female) (Lincoln)
*
Choose a Backup option
Any Black Female Clinician (Fastest Method)
Partaja Spann, MA (2.5 Months)
Sabrina Joseph, LCSW (3 month wait)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (Black female) (Dedham)
*
Select the Therapist you want most.
Any Black Female Clinician (Fastest Method)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Monica Nantege, MSW (3 week wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of In-Person Clinician (Black female) (Dedham)
*
Choose a Backup option
Any Black Female Clinician (Fastest Method)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Monica Nantege, MSW (3 week wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first one chosen.
1st Choice of Telehealth Clinician (Black) (All Locations)
*
Select the Therapist you want most.
Any Black Clinician (Fastest Method)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of Telehealth Clinician (Black) (All Locations)
*
Choose a Backup Option
Any Black Clinician (Fastest Method)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Elizabeth Smith, (Intern) (1month wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Partaja Spann, LCSW (2 month wait)
Isoken Osazee, LCSW (2.5 month wait)
Breyaunna Smith, MA (3 month wait)
Sabrina Joseph, LCSW (3 month wait)
Charles Boateng, (Intern) (3 month)
Chukwudi Ugwu, MSW (3.5 months wait)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first.
1st Choice of In-Person Clinician (Black) (Dedham)
*
Select the Therapist you want most.
Any Black Clinician (Fastest Method)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
2nd Choice of In-Person Clinician (Black) (Dedham)
*
Choose a Backup Option
Any Black Clinician (Fastest Method)
Monica Nantege, MSW (2 week wait)
Shamiah Tasker-Cheeks, (Intern) (2 week wait)
Janellia Jolley, (Intern) (1 month wait)
Kendra Lisenby, MA (1 month wait)
Nerissa Fagan, MA (1.5 month wait)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
Dr. LaTasha Sarpy, LICSW (Unavailable)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (Black) (Lincoln)
*
Select the Therapist you want most.
Any Black Clinician (Fastest Method)
Partaja Spann, MA (2.5 Months wait)
Sabrina Joseph, LCSW (3 month wait)
2nd Choice of In-Person Clinician (Black) (Lincoln)
*
Choose a Backup Option
Any Black Clinician (Fastest Method)
Partaja Spann, MA (2.5 Months wait)
Sabrina Joseph, LCSW (3 month wait)
Select a different option than the first one chosen.
1st Choice of Telehealth Clinician (Black Male) (All Locations)
*
Select the Therapist you want most.
Any Black Male Clinician (Fastest Method)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
2nd Choice of Telehealth Clinician (Black Male) (All Locations)
*
Choose a Backup Option
Any Black Male Clinician (Fastest Method)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (Black Male) (Dedham)
*
Select the Therapist you want most.
Any Black Male Clinician (Fastest Method)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
2nd Choice of In-Person Clinician (Black Male) (Dedham)
*
Choose a Backup Option
Any Black Male Clinician (Fastest Method)
Charles Boateng, (Intern) (3 month)
Thaddieus Sarpy, LMHC (Unavailable)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (Black Male) (Lincoln)
*
Select the Therapist you want most.
No Black Males in Person
2nd Choice of In-Person Clinician (Black Male) (Lincoln)
*
Select the Therapist you want most.
No Black Males in Person
1st Choice of Telehealth Clinician (LatinX) (All Locations)
*
Select the Therapist you want most.
Any LatinX Clinician (Fastest Method)
Angel Garcia, LMHC (0.5 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Elliette Utset, MS (3 week wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
2nd Choice of Telehealth Clinician (LatinX) (All Locations)
*
Choose a Backup Option
Any LatinX Clinician (Fastest Method)
Angel Garcia, LMHC (0.5 week wait)
Samantha Quevedo, (Intern) (1 week wait)
Elliette Utset, MS (3 week wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Select a different option than the first.
1st Choice of In-Person Clinician (LatinX) (Dedham)
*
Select the Therapist you want most.
Any LatinX Clinician (Fastest Method)
Samantha Quevedo, (Intern) (1 week wait)
Elliette Utset, MS (2 week wait)
2nd Choice of In-Person Clinician (LatinX) (Dedham)
*
Choose a Backup Option
Any LatinX Clinician (Fastest Method)
Samantha Quevedo, (Intern) (1 week wait)
Elliette Utset, MS (2 week wait)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (LatinX) (Lincoln)
*
Select the Therapist you want most.
Any LatinX Clinician (Fastest Method)
Angel Garcia, LMHC (0.5 week wait)
Cindy Gonzales, MA (1 Month wait)
2nd Choice of In-Person Clinician (LatinX) (Lincoln)
*
Choose a Backup Option
Any LatinX Clinician (Fastest Method)
Angel Garcia, LMHC (0.5 week wait)
Cindy Gonzales, MA (1 Month wait)
Select a different option than the first one chosen.
1st Choice of Telehealth Clinician (LatinX Female) (All Locations)
*
Select the Therapist you want most.
Any LatinX Female Clinician (Fastest Method)
Samantha Quevedo, (Intern) (1 week wait)
Elliette Utset, MS (2 week wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
2nd Choice of Telehealth Clinician (LatinX Female) (All Locations)
*
Choose a Backup Option
Any LatinX Female Clinician (Fastest Method)
Samantha Quevedo, (Intern) (1 week wait)
Elliette Utset, MS (2 week wait)
Dariana Quinones-Rexach, LCSW (3 Month wait)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (LatinX Female) (Dedham)
*
Select the Therapist you want most.
Any LatinX Female Clinician (Fastest Method)
Samantha Quevedo, (Intern) (1 week wait)
2nd Choice of In-Person Clinician (LatinX Female) (Dedham)
*
Choose a Backup Option
Any LatinX Female Clinician (Fastest Method)
Samantha Quevedo, (Intern) (1 week wait)
Select a different option than the first one chosen.
1st Choice of In-Person Clinician (LatinX Female) (Lincoln)
*
Select the Therapist you want most.
Cindy Gonzales, MA (1 Month wait)
2nd Choice of In-Person Clinician (LatinX Female) (Lincoln)
*
Choose a Backup Option
Cindy Gonzales, MA (1 Month wait)
Select a different option than the first one chosen.
1st Choice of Telehealth Clinician (LatinX Male) (All Locations)
*
Select the Therapist you want most.
Angel Garcia, LMHC (0.5 week wait)
2nd Choice of Telehealth Clinician (LatinX Male) (All Locations)
*
Angel Garcia, LMHC (0.5 week wait)
1st Choice of In-Person Clinician (LatinX Male) (Dedham)
*
Select the Therapist you want most.
No LatinX Males available
2nd Choice of In-Person Clinician (LatinX Male) (Dedham)
*
Select the Therapist you want most.
No LatinX Males available
1st Choice of In-Person Clinician (LatinX Male) (Lincoln)
*
Select the Therapist you want most.
Angel Garcia, LMHC (0.5 week wait)
2nd Choice of In-Person Clinician (LatinX Male) (Lincoln)
*
Select the Therapist you want most.
Angel Garcia, LMHC (0.5 week wait)
1st Choice of In-Person Clinician (Any) (Lincoln)
*
Select the Therapist you want most.
Any Clinician (Fastest Method)
Angel Garcia, LMHC (0.5 week wait)
Kimberly Palmisano, (Intern) (1 week wait)
Sabrina Joseph, LCSW (3 month wait)
Maia Roper, LICSW (4 Months)
2nd Choice of In-Person Clinician (Any) (Lincoln)
*
Choose a Backup Option
Angel Garcia, LMHC (0.5 week wait)
Any Clinician (Fastest Method)
Kimberly Palmisano, (Intern) (1 week wait)
Sabrina Joseph, LCSW (3 month wait)
Maia Roper, LICSW (4 Months)
Select a different option than the first.
Do you know of any friends or Relatives who are currently receiving services at GENNEW?
*
Select Choice
No
Yes
What is the persons name?
*
Please select all of the following which pertain to the client.
Addiction - Pornography
Addiction - Substances
Feeling - Anxiety
Feeling - Depression
Feeling - Guilt / Shame
Feeling - Obsessive or Intrusive Thoughts
Feeling - Violent of Aggressive behaviors
Feeling - Unhealthy Relationship with Food
Currently - Taking prescribed medication for symptoms
Previous / Current - Department of Youth Services
Previous / Current - Discharged from program or Hospital
Previous / Current - Homelessness
Previous / Current - Issues with the law
Previous / Current - Mental Health diagnosis formally diagnosed
Previous / Current - Suicide Ideation
Previous / Current - Suicide Attempts
Previous / Current - Therapy with another provider
What medication? Please add frequency and dosages.
*
What provider made the formal diagnosis?
*
What was the diagnosis?
*
How recent was the last suicide attempt?
*
When was the last session and what was the therapists name?
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Reason for transition?
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Can you share why you are no longer with the previous therapist?
What is the name of the program or hospital?
*
When is/was the discharge date from program or hospital?
*
Who are you completing this referral for?
*
Please Choose
Myself
My Family Member
My Client
Please explain your relation to the potential client.
Referrer Name
*
First
Last
Referrer Email
*
Referrer Phone
*
Do you have a referral / case number?
Your insurance provider may have given you a Case / Referral #
What issue caused you to seek therapy?
*
Please be very detailed so that we can match you to the appropriate therapist. The more we know the better we can match you with an appropriate therapist. Please don't just put depression, please share what you think may be causing the depression or any issues going on in your life.
Client Availability for sessions? Dates and Times
*
Please share the earliest time each day that you would be able to either come to the office or to start telehealth. ex: if you finish work at 4pm please put the earliest time at 4:30 to give yourself travel and or prep time for the session. The more specific you are the more likely you will be scheduled sooner. The more days and times given, the quicker you will be assigned.
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