Open Door Therapy, LLC | SimplePractice

Open Door Therapy, LLC Send Message

Who would be receiving care?

My partner and me

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Reason for care

Why are you seeking therapy and/or assessment at this time?

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What kind of care is being sought?

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Individual Psychotherapy Couples / Family Therapy Assessment Services Assessment Services and Psychotherapy

Is there anything else you would like me to know?

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Administrative

How did you find out about me?

What appealed to you most about my website?

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Billing & Payment

Payment

How do you plan to pay for services?

If you selected Insurance (In Network benefits), we will discuss options that may be available.

While I am out of network, there are often exceptions we can request from your insurance that may allow you to use in network benefits.

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Client Preferences

Preferred appointment times

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Morning (11am - 12pm) Afternoon (12:30pm - 3:30pm) Evening (4pm - 5pm)

In Person or Telehealth?

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In Person Telehealth No Preference

Communication Preference

Text Email No Preference

Day of the week preference?

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Monday Tuesday Wednesday Thursday No preference

Check here to acknowledge understanding that I am out of network with all insurance plans.

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Check here to acknowledge understanding that I currently have a waitlist and cannot accept new clients immediately.

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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice.