Let’s work together.

Name *

First Name

Last Name

Phone *

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Residence: Do you live in Georgia?

Yes, I am a resident of Georgia.

No - I understand I will receive a referral. Seen Therapy & Wellness can only serve clients who live in Georgia. (If so, please consider other providers who may be able to service clients in your state).

Please select the areas that brought you to therapy (choose all that apply): *

Anxiety

Depression

Relationship concerns

Trauma/PTSD

Family of Origin Concerns

Life Transitions

Stress/Burnout

Body Image or Disordered Eating Concerns

Traditional Talk Therapy

EMDR Therapy

I am seeking traditional talk therapy, but I am interested in learning more about EMDR therapy.

Other:

Please be advised that I do not specialize in the following areas, and I highly recommend that you seek assistance from a clinician with expertise in these topics: *

Family Therapy - Cura for Couples, Intown Family Therapy Couples therapy - Ayanna Abrams, Psy.D.; Natalie Milom, LCSW; Cura for Couples Therapy for adolescents or children - Mary Huffstead, LPC, PhD Divorce - Thandi Chase, LCSW Maternal mental health / adjusting to motherhood - Whitney A. Bowles, Ph.D. Personality disorders - North Atlanta DBT Psychosis / schizophrenia - Valerie Dunham-Maxey, LCSW Anorexia - Lindsey Cope, LCSW; Herani Argoe, LPC (note: I specialize in those in recovery or those with subclinical binge eating disorders, bulimia or anorexia, binge-purge type eating disorders only) Substance Use - Healing Tree Counseling Services

I understand and do not need support in these areas.

What is your history with mental health: *

Please select all that apply.

In therapy now

In therapy in the past

Taking psychiatric medication now

Taken psychiatric medication in the past

Hospitalized for mental health reasons now or recently

Hospitalized for mental health reasons in the past

Known or previously diagnosed personality disorder

Known or previously diagnosed autism spectrum disorder

Attempted suicide in the past

None of these apply

Availability: Seen Therapy & Wellness has weekday evening availability Monday - Wednesday, and daytime availability on Friday, with some availability on Saturday mornings. Please indicate that this availability works for you.

Yes, evening, weekend, and Friday daytime availability works for me.

No, I will need different availability. (If so, please consider other providers who may be able to accommodate your availability needs).

Telehealth: I offer mostly telehealth appointments, with limited in-person appointments at Emory University on select Wednesday evenings only.

Yes, this works for me. I prefer mostly telehealth appointments.

I am seeking in-personal appointments only. (If so, please consider other providers who may be able to accommodate your availability needs).

Fees: By selecting “yes” below, you acknowledge that I am a private pay/out-of-nework provider and do not bill directly to insurance. You can learn more about my fees here and options for reimbursement here.

Yes, I acknowledge that I have read over the private pay fees for therapy.

No, I would prefer to use insurance only (no reimbursements) and will accept a referral.

Would you prefer a phone call for the consultation or a video appointment? *

Please select one.

Phone consultation (15-minutes)

Video consultation (15-minutes)