First Name

Last Name

Phone *

Email *

Is it okay for us to leave a voicemail?

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Do you have Medicare?

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Services You're Interested In:

Child Therapy

Adult Therapy

Intensive Therapy (several hours per day)

OCD Online Group Program

ADHD/Autism/Other Testing

If you are seeking services for a child under 18: Are there other parents or guardians who need to provide consent for your child to obtain therapy services?

Yes
No
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Symptoms you or your child are experiencing:

OCD

Panic Attacks

Social Anxiety

Generalized Anxiety

Perinatal/postpartum anxiety

Emetophobia (fear of vomiting)

Overthinking/rumination/worry

Fear of Flying

ADHD

Body Focused Repetitive Behaviors (skin picking, hair pulling)

Child Behavioral Problems (tantrums, meltdowns)

Parenting Stress

How did you find us?

Internet Search

From Psychology Today

Friend/Family

Doctor

Therapist

School

Returning Client

Name of doctor or therapist if referred by someone:

Please select a therapist preference below Learn about therapist specialties here.

Therapist Preference

Maria Cognata LMSW ($115)
Dr. Jaime Murtagh ($155)
Amy Kurz LCSW ($155)
Dr. Sam Kramer ($185)
Dr. Sarah Kertz ($225)
Group Therapy ($65)
No Preference
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What is your biggest struggle? If requesting for your child, what is their biggest struggle?

What would successful therapy look like? What would be different when therapy is over?

We do not accept insurance. We do accept HSA, FSA, and credit cards. You'll be responsible for the full fee at the time of session. You may be eligible for out of network reimbursement from your insurance company. You can check your out of network benefits by calling the phone number for behavioral health on the back of your insurance card. We're happy to provide a superbill for you to submit to your insurance company for potential reimbursement. What questions do you have about fees or out of network reimbursement?

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