New Client Intake Form

Thank you for your interest in working with Head/Heart Therapy. Please allow at least 24 business hours for a response. Please make sure to check your spam folder for emails from intake@headhearttherapy.com. If you do not hear from us, feel free to reach out to that address directly.

Please note that we cannot accommodate mental health emergencies. If this is a mental health emergency, please call 911 or go to your nearest emergency room.

Please consider the following before filling out this intake form:

1. We are in-network with BlueCross BlueShield PPO plans, Aetna and United/Optum plans. We do have availability for self-pay clients, and some limited availability for sliding scale.

2. We are currently operating under a hybrid model. Some therapists have in-person availability, but that will be dependent upon a particular therapist's availability. All clients wanting to see their therapist in person must present proof of vaccination against COVID-19.