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Convenient "1-2-3" Self-Service Client Registration & Appointment Booking


We're excited about meeting you!  

This form is used for new and *returning clients to request an appointment to make scheduling easy and effortless!  This pertinent form let's us gather basic information, insurance information, and it is used to briefly identify the reasons a prospect client is interested in counseling, if an appropriate client-clinician match, we will both register you as a client, and verify your outpatient mental health benefits. 


What happens next? 

Upon receipt of your APPOINTMENT REQUEST FORM, we will promptly review you submission.  If prospect client is not a match we will provide referrals.   If an appropriate client-clinician match, subsequently we will provide you will a Good Faith Estimate of the expected cost of your therapy services i.e. cost of Intake Session(s) and cost of Ongoing Therapy Session(s), ect. and schedule your Intake Appointment based on noted availability.  

Simply, Reply back "C" to Welcome Message with Good Faith Estimate to Confirm Appointment and or we may send Good Faith Estimates via an e-mail for clients to review and sign off on.  

Thank you,


The Pink Positive Psychology Team

*Returning clients are previous clients that have not been seen for more than 2-months and or current clients with new health insurance.


Blue Cross Blue Shield - PPO
Blue Care Network

Evernorth Behavioral Health

Golden Rule



Out-of-State - Blue Cross Blue Shield Plans

Priority Health

Tricare East
United Behavioral Health


Insurance Opt Out / Self-Pay Rate:  $200.00 

You may use this convenient tool to schedule your first appointment.  For existing clients, please contact your therapist directly at 586-209-7092 to make follow-up appointments. Thank you.

*Please make sure to have all INTAKE FORMS (below) filled out 48-hours prior to your appointment to secure appointment.

Step 3:  Confirm Your Appointment

Upon receipt of your APPOINTMENT REQUEST FORM, we will promptly review you submission and verify your insurance eligibility.  This process is normally completed same business day - but in some cases, may take up to two business days to complete. 


We send a Welcome Message with the following information: 

  • Date & Time of Your Appointment (with Your Chosen Clinician) 

  • Billing & Payment Information via a Courtesy Benefits Quote 

  • Mobile Friendly Electronic Intake Forms Needed 48-Hours in Advanced 

  • Client Portal 

  • Virtual Waiting Room Link

Simply Reply "C" to Confirm Your Appointment.

Yes, scheduling it's really that simple!