top of page
3-Girls Lauging for Website - Client On-Boarding.jpeg



START HERE:  Please fill out An Appt. Request & Insurance Verification Form

Getting Started: Get Involved

PRO TIP:  Take Pictures of Drivers License/ID (front & back) & Health Insurance Card/s (front & back) BEFORE filling out this form. 

Appointment Request & Insurance Verification Form

For all *Prospect Clients and Returning Clients, this 5-7 minute form assists us in understanding your treatment needs, ensuring an optimal client-clinician match. It also captures your scheduling preferences. Kindly complete and submit this form, and we'll swiftly provide you with a **Benefits Quote** and arrange your Intake Session based on your preferences. 


What's the Next Step? 

You'll receive a Welcome Message with:

To confirm the Intake Appointment, simply reply with "C".  

It's that easy to schedule with me!

Warm Regards, 

Melissa E. Mendoza, LMSW





🔗LinkTree Link:

*If not a match we will provide referrals.

**No obligation or cancellation fees if you decide not to proceed with the session based on the provided benefits quote.

***All Forms are Mobile Friendly / Electronic Forms that are HIPPA compliant and ENCRYPTED which means your information is safe and secure.

bottom of page