Name *

First Name

Last Name

Phone

(###)

###

####

Payment type

Private pay(cash, check, card) ok.

I would like recommendations for agencies who take insurance (Align Couples Therapy does not bill insurance)

Mode of Counseling requested

1:1

Couples

Family

Marathon Intensive Assessment

Marathon Intensive Assessment + Head Start

Marathon Intensive

The Daring Way™ workshops(Daring Greatly, Rising Strong, Bold for Teens)

Online telehealth preferred

Face to Face therapy preferred

Clinician requested: *

Krista Miller, LMFT, LCDC: $155/hr, M-F: 9-3pm

Ashley Lundquist, LMFT, LCDC(telehealth only): $135/hr, Monday-Thursday 10a-9p, Sunday 10a-2p

Claire Fallin, LPC: $135/hr: M/W 11am-7pm, T, TH, F 8-5

Paola Misteli, LPC: $135/hr, M-F: 9-5, Evenings, Saturdays

Lisa Aguilar, LPC: $135/hr M-F, daytime, evening

Savannah Coffey, MA, LMFT: $135: weekday and evenings

Yaira Rosa, MS, LMFT-Associate(telehealth only), $125, Sun-Thur 3-8pm

No preference, please recommend the right fit for me

Name *

First Name

Last Name

Phone

(###)

###

####