Name * First Name Last Name Email * Phone (###) ### #### Where are you located (which state)? * New York Maryland Arizona California None of these How did you hear about us? * What kind of therapy are you seeking? * Individual Therapy (Generalist) Individual Therapy (Sex / Relationship) Couples/ Relationship Therapy (Generalist) Couples/ Relationship Therapy (Focusing on Sex/ Intimacy) Workshop/ Training/ Programming for my Event Do you have Insurance you are hoping to use? * *Please name the type of insurance you have. We are In-Network with some panels, and Out Of Network with others). We can also offer a Reduced Fee as needed. Who are you hoping to work with? * Please name your preferred Therapist Jessica Massaro, LCSWR, CST Cara Cole, LCSW, LCSW-C Aimee Emmrich, LMHC, LPC, LPCC Courtney MaeRose, LCSW Qiana Watson, LCSW Toby Hawkins, LCSW Please share a little bit about your reason for seeking care at this time. * Thank you! Someone will be in touch with you within 24 hours. If you do not receive an emailed response within that timeframe, please reach out to us again. We do not tend to work weekends, so please look for a response on the next business day. Let’s work together We are a FULLY Remote Teletherapy Practice offering you support in NY, MD, AZ & CA
