Name *

First Name

Last Name

Phone

(###)

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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: $195/hr, M-F: 9-3pm

Ashley Lundquist, LMFT, (telehealth only): $165/hr, Monday-Thursday 11a-9p, Sunday 2pm-7pm

Claire Fallin, LPC: $165/hr: Tue/Fri 10-4, Thurs 11-7, Wednesday(virtual) 11-5

Paola Misteli, LPC: $165/hr, M-F: 9-5, Evenings, Saturdays

Julian Spain-Ledezma, LMFT-Associate: $135/hr, M 12-8pm, F 12-8pm, EO Saturday

Amanda De Santiago, MS, LMFT-Associate: $135/hr, W 11-4, Sun 11-3pm

No preference, please recommend the right fit for me

Name *

First Name

Last Name

Phone

(###)

###

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