top of page
Date of Birth
Month
Day
Year
Are you seeking:
In-person therapy Apple Valley, CA
In-person therapy Riverside, CA (Waitlist only on Fridays)
Telehealth therapy (California)
Telehealth Texas (Cash pay or Lyra)
Is this for:
Individual Therapy
Couples Therapy
Family Therapy
If a minor, are there custody or court orders on file?
Yes
No
Insurance (We currently only accept the insurances on this list).
IEHP
IEHP Covered California
Lyra
I will be paying out of pocket ($200.00 per 53-minute Session) Individual
I will be paying out of pocket ($225.00 per 50-minute Session) Couples or Family Therapy
bottom of page