Join Our Waitlist. Name * First Name Last Name Email * Phone * (###) ### #### What is your birthdate? * MM DD YYYY Please describe why you are seeking counseling services at this time. * What services are you interested in? * In-Person Sessions Online Sessions Do you have a preference in Therapist? * Yes, please add me to Tonya Lundahl's waitlist. Yes, please add me to Hilary Hampton's waitlist. No, thank you. I am happy to take the first available spot. If you do have a preference in Therapist, can you tell us why? As payment is due at the time of service, please indicate if you plan to pay with insurance or self pay. * Insurance Self Pay Unsure If you plan on paying with insurance, who is your insurance provider and which plan do you have? We currently accept plans from Optum (United and UMR), Aetna, Blue Cross Blue Shield. Select Health (Care, Choice, Share, Med, and Value), and EMI Health Where did you hear about our services? * Thank you! We will reach out within 24-48 hours to confirm your application has been accepted.
