Balanced Living Therapy LLC

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Takes about 2 minutes. Only our staff see your answers. Privacy policy

Our front desk reads every submission and reaches out, usually within a day, to check your coverage and match you with a clinician. If you'd rather talk first, call us.

Who this is for

Who is this form for?
Date of birth (person coming to therapy)

How to reach you

Preferred contact method

Insurance

Pick Self-pay if you won't be using insurance.

When and what

Session format
Preferred days
Preferred times
Presenting concern

Check all that fit.

Check your answers, then