Request Free Consult Therapy Consult Who is this appointment for? * You can request this 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. 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 Kylee Rucker, Therapy Intern - 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! Return home
