Request appointment | TheraListen

How will you be paying for sessions?

I will be using insurance I will be paying out-of-pocket (self-pay)

Name of Insurance Provider

Please write n/a if you will be paying out-of-pocket

What is your Policy number?

Please write n/a if you will be paying out-of-pocket

On the back of your card there is a number specifically for Providers. Please enter here.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.