BEGIN THERAPY NOW about us request free consult Therapy Consult Who is this appointment for? * You can request an appointment for yourself, on behalf of someone else, or for both you and your partner. Please choose below. Me My Partner and Me Someone Else Contact Name * First Name Last Name Client Information * This will only be shared within the practice. First Name Last Name Client Email * Client Phone * (###) ### #### Client Date of Birth * Therapist Preference Select the therapist(s) of interest. Availability of selected therapist(s) may vary. Tallia Doyle, LCSW - 1-2 week waitlist, in-person & virtual sessions Christine Turner, LCSW - not accepting new clients Sarah VanderVliet, LAC - virtual sessions, out-of-pocket only Karl Kleppe, LAC - in-person & virtual sessions, out-of-pocket only Payment Preference * Select preferred payment option(s). Out-of-Pocket (HSA/FSA, Cash, Card, Zelle, etc) In-Network Insurance (Aetna or United for Tallia Only) Out-of-Network Insurance with Superbill Appointment Location * In-person Virtual Video Via Phone Appointment Availability - Days * Please select the day(s) you are available for an appointment from the options below: Monday Tuesday Wednesday Thursday Friday Saturday Appointment Availability - Times (30 mins) * Please select the time(s) you are available for an appointment from the options below: Morning Noon Afternoon Evening How did you hear about us? * Thank you for your request! Allpeopletherapy will get back to you shortly! request free consult Therapy Consult Who is this appointment for? * You can request an appointment for yourself, on behalf of someone else, or for both you and your partner. Please choose below. Me My Partner and Me Someone Else Contact Name * First Name Last Name Client Information * This will only be shared within the practice. First Name Last Name Client Email * Client Phone * (###) ### #### Client Date of Birth * Therapist Preference Select the therapist(s) of interest. Availability of selected therapist(s) may vary. Tallia Doyle, LCSW - 1-2 week waitlist, in-person & virtual sessions Christine Turner, LCSW - not accepting new clients Sarah VanderVliet, LAC - virtual sessions, out-of-pocket only Karl Kleppe, LAC - in-person & virtual sessions, out-of-pocket only Payment Preference * Select preferred payment option(s). Out-of-Pocket (HSA/FSA, Cash, Card, Zelle, etc) In-Network Insurance (Aetna or United for Tallia Only) Out-of-Network Insurance with Superbill Appointment Location * In-person Virtual Video Via Phone Appointment Availability - Days * Please select the day(s) you are available for an appointment from the options below: Monday Tuesday Wednesday Thursday Friday Saturday Appointment Availability - Times (30 mins) * Please select the time(s) you are available for an appointment from the options below: Morning Noon Afternoon Evening How did you hear about us? * Thank you for your request! Allpeopletherapy will get back to you shortly! request free consult Training & Consult Contact Name * First Name Last Name Email * Who Needs Support? * Check all that apply Me My Team My Organization Phone (###) ### #### Organization What Are Your Immediate Needs? How did you hear about us? * Thank you for your request! Allpeopletherapy will get back to you shortly! shirts hats hoodies totes Convo emotions dating Worksheet workbook
