Schedule Your Online Therapy Appointment

Schedule Online Therapy for Anxiety, Mental Health & Counseling Services

Therapy and Appointment Preferences

Which service are you interested in?

What are the reasons you're seeking therapy or medication management?

Do you have a preference for a specific gender of therapist?

Is there a particular ethnicity you prefer for your therapist?

(Note: While we cannot guarantee your exact preference, we will make every effort to find the best match for you.)

Appointment Time and Day Preference

Weekday Mornings (Monday-Friday, 8:00 AM-12:00 PM)

Weekday Afternoons (12:00 PM-5:00 PM)

Weekday Evenings (6:00 PM-9:00 PM)

Weekends (Saturday-Sunday, 9:00 AM-1:00 PM)

How soon would you like to be seen?

Contact Information

Name

First Name

Last Name

What is your date of birth?

MM

DD

YYYY

Email

Home Address

Phone

(###)

###

####

Is this a cell phone?

Yes

No

Insurance Information

Insurance Company Name:

Insurance ID#:

(We are currently enrolled with UPMC and Highmark.)

We value your privacy. All information submitted through this form is protected and handled in accordance with HIPAA compliance standards.