Free 20 minute Phone Consultation Request

Thank you for your interest in working with me.

Name

First

Last

Phone Number

Your City and State (You must be located in Arizona)

Are you interested in:

Telehealth
In person, in Tempe, Arizona
A combination of Telehealth and In person.

When are you available by phone for the consult? (Best days/time windows)

I will do my best to call you within your preferred day/time window, but cannot guarantee that availability.

I am 18 years of age or older.

I am seeking therapy services for myself and not someone else.

A free 20 minute consult is offered only for the person who will participate in therapy. If you are inquiring about therapy for someone else, please ask that person to reach out to me themselves. It is a violation of confidentiality for me to discuss therapy issues with a third party.

week accept from

I understand this is a direct pay practice that does not accept payments from insurance

My rate is currently $200 for an initial 50 minute session and $200 for each 50 minute follow up session. Initially, we may meet once a week for the first few weeks, then meet every other week, depending on your needs and goals. Are you able to commit both financially and time-wise to this arrangement?

Yes, I am ready and able to make this investment in my mental health and wellness.

Yes, I want to submit this form.

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking “yes, I want to submit this form” you agree to hold Taana Abbitt and The Awakened Heart harmless for unauthorized use, disclosure, or access to your protected health information sent via this electronic means.