Request an Appointment

Please share the name that appears on the clients insurance member ID card, or State ID.
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Please verify that this date is correct before moving to the next item. Make sure to change the year section from 2024.
Is the identified client named above over 18 years old?
Click or drag a file to this area to upload.
You can take a picture with your cellphone and upload it here.
Select yes if you were told about a specific opening or you have a case or referral number.
If you have commercial insurance please share the member ID here. If you have MassHealth please share both the masshealth number as well as the Member ID for the type of MassHealth you have. This would be two separate member numbers.
Click or drag a file to this area to upload.
Please upload a picture of the ID card if you have it. You can use a cellphone to take the picture and email it to yourself for upload here if needed.
For possible in person sessions the location will determine clinicians available to you in later steps.
Selecting no preference for Gender will give the client the most possible options for assignment. This is the fastest of all of the choices.
Please know that we have different providers for different services. Due to the pandemic the in person services are less available while telehealth options are more flexible and expansive at the moment.
Weekly sessions are the traditional start. This is one session every 7 days. = 4 sessions a month. Biweekly is a reduced frequency being one session every 2 weeks. = 2 sessions a month Monthly is a reduced frequency being one session every 4 weeks. = 1 session a month
This helps us prevent offering you matches for a clinician that is already working with close matches.
Please explain your relation to the identified client at the start of this form.
Share what days of the week you can participate in a scheduled session consistently. The sessions will be 40-50 minutes
We will try our best to send matches that are within these selections. The more availability you have the more matches that are possible.
Please specify on each day selected the earliest and latest you can participate in sessions. This helps us determine better matches for you. Please consider after school activities or work related obligations.
What brings you to counseling at this time? How long has it been happening? is there anything that we should know before scheduling? Be as detailed as you can. This helps us decide which therapist is the most appropriate for you.