Name * First Name Last Name Email * Phone * (###) ### #### Where did you hear about us? * Facebook/Social Media Google Search GMU My Doctor My Therapist NoVa CC Other Our Website Past/Current Client Psych2Day Returning Client School Staff Speaking Event STBH What therapy services are you inquiring about? Check all that apply * Individual Counseling Family Counseling Group Counseling Virtual/Telehealth In Person Therapy What is your preferred appointment time? * Mornings ( Before 12pm) Afternoons (12pm-4pm) Evenings (After 4pm) Which clinician would you like to see? * Katherine Bolin, M.A Karen Wee, LMSW (Mandarin Speaking Therapist) No Preference What state are you located? Virginia Maryland Other How are you going to pay for services? * Insurance Self-Pay Out-of-Network Open Path If Insurance, what do you have? In your own words, what is bringing you into therapy? * Thank you for reaching out. Your message is very important to us. Please note that our offices are currently closed so that staff can take time off for some much-needed mental and emotional self-care. We will be back in the office on Monday October 2nd. Schedule An AppointmentWe will try our best to accommodate your request and will be in touch as soon as possible.
