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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. 

*Request My Appointment & Verify My Insurance Form

This *required form is for Prospect Clients & Returning Clients to gather basic information such as reason/s for seeking treatment to determine Client-Clinician Match; Preferred Days/Times for Therapy Session/s, and Health Insurance/Private Pay Information. Please submit this form so we may promptly provide you with a Benefits Quote / "Good Faith" Estimate and schedule your Intake Appointment according to your preferences.


What Happens Next? 

You'll receive a Welcome Text Message with:

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

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.

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