Who is getting therapy?
This could be you or someone else, like a family member.
What kind of therapy are you looking for?
Individual Therapy
Couples Therapy
Medication Management
How will you pay for therapy?
Aetna
Blue Cross
Blue Shield
Cigna
Compsych
Kaiser NorCal
Kaiser SoCal
Medicare
Medicare Advantage
Optum
Scan
Sutter
UMR
United Healthcare
Some other insurance plan
I will pay for therapy myself
Preferred name
Legal first name
(if different from above)
Legal last name
Date of Birth
Gender
Woman
Man
Non-binary
Prefer not to answer
Email
Phone
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