Counseling Inquiry Name * First Name Last Name Email * Phone Number * (###) ### #### Age * Age of the person seeking services Method of payment * If using insurance, please enter name of insurance company below Private pay Insurance Insurance company (if applicable) Preferred day(s) for weekly therapy: * Check all that apply Monday morning Monday afternoon Tuesday morning Tuesday afternoon Wednesday morning Wednesday afternoon Thursday morning Thursday afternoon Friday morning Friday afternoon Preferred gender of therapist: * Female Male No preference Do you hope to attend therapy: * You may choose one or both options In person Virtually How can we help? * Explain your main interest in contacting the Martin Center for Integration (marriage counseling, individual therapy, etc.) and anything you'd like us to know about you. Thank you for reaching out to the Martin Center for Integration for counseling and psychotherapy services. You have been placed on our waiting list and someone will be in touch as soon as an opening is available.While you are waiting to be placed, we highly recommend reading our FAQs and our clinicians' bios HERE. You will also find information about each clinician's insurance networks and private pay rates at the bottom of their respective pages.If you are experiencing a mental health emergency, please go to your nearest emergency department or call 911.
