Request Free Consult Therapy Consult Who is this appointment for? * You can request this appointment for yourself, on behalf of someone else, or for both you and your partner. Please choose below. Me My Partner and Me Someone Else Contact Name * First Name Last Name Client Information * This will only be shared within the practice. First Name Last Name Client Email * Client Phone * (###) ### #### Client Date of Birth * Therapist Preference Select the therapist(s) of interest. Tallia Doyle, LCSW - 1-2 week waitlist, in-person & virtual sessions, United, Aetna, BCBS or out-of-pocket Christine Turner, LCSW - not accepting new clients Angelina Villalpando, LMSWT - in-person & virtual sessions, Aetna & BCBS or out-of-pocket Karl Kleppe, LAC - in-person & virtual sessions, Aetna & BCBS or out-of-pocket Payment Preference * Select preferred payment option(s). Out-of-Pocket (HSA/FSA, Cash, Card, Zelle, etc) In-Network Insurance (United, Aetna, BCBS for Tallia Only -- Aetna, BCBS for Angelina & Karl) Out-of-Network Insurance with Superbill Appointment Location * In-person Virtual Video Via Phone Appointment Availability - Days Please select the day(s) you are available for an appointment from the options below: Monday Tuesday Wednesday Thursday Friday Saturday Appointment Availability - Times (30 mins) * Please select the time(s) you are available for an appointment from the options below: Morning Noon Afternoon Evening What brings you to therapy? * Share a little about your goals, challenges, or what you’d like to focus on. How did you hear about us? * Thank you! Return home
