New Client Booking Form Sliding Scale Application Name * First Name Last Name Email * What support are you looking for? * Check all that apply Psychotherapy/ Couples Therapy Therapy Intensives (4 hours or 20 hours) Healing Attachment Wounds Online Course Couples Wellness Online Course Wisdom Within You Holsitc Wellness Community Why are you seeking support at the moment? What are your goals? What about my approach is appealing for your support and growth? * Have you seen a therapist before? Explain. * How were you referred to me? * Checkbox * Private Pay (starting at $215/session for individuals and $250 for couples) Sliding Scale (must fill out application- starting at $180 ) Out-of-Network Superbill (call your insurance and ask if you have out of network benefits or use Reimbursify (https://reimbursify.com/individual-page/)) Online Course or Membership (various prices) Intensives (varies based on needs) Thank you! Kali will be in touch soon.
