Free Consultation Let’s Talk. Request a free consultation with me by filling out your info below… "*" indicates required fields Your Name:* Email Address:* Phone Number:*Address:* Prospective Client's Date of Birth:* MM slash DD slash YYYY Insurance Member ID:* Preferred Therapist*Preferred TherapistMelissa Jenneman, MSW, LCSW, PMH-CEmily Linsmeyer, MSW, APSWRebecca Pollak, APSWTiffani Lajeunesse, LCSWNichole Bresina, LCSWBethany Geske, MSN, APNP, PMHNP-BCMattie Nicholson, MSW, CSWSavannah Gray, LPC-ITNo preferenceWhat is your insurance carrier?*What is your insurance carrier?OptumGroup Health CooperativeSecurity Health PlanQuartzBenefit Plan AdministratorsDean Health Plan/Prevea 360MedicaForward HealthUMRCignaSurestAll SaversOscarOxfordCash PayAetnaBCBS/AnthemOtherPlease list your insurance carrier* Upload a photo of the front side of your insurance card.*Max. file size: 20 MB.Upload a photo of the back side of your insurance card.*Max. file size: 20 MB.Is this a commercial plan or forward health?* Message*How did you hear about us so we can send them a Thank You?* PhoneThis field is for validation purposes and should be left unchanged.