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Do you have private health care insurance?

Yes

No

Unsure

If so, who is your insurance provider, and what kind of therapy do they cover?

Are you okay with Secure Video or Phone Sessions?

Yes

No

Which days of the week often work best for you?

Which age ranges apply?

What do you need help with?

If you selected "Other" from the above options, please specify below what you would like help with.

Do you have any previous diagnosis