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Online Counseling Services

Therapy Request Form & Cancellation Policy

New clients please complete the "Counseling Request" form below. Be sure the information is accurate. New clients can request a free 15 minute consultation to be sure online therapy is best for you. Text 734.968.0218 or email with your request.

New clients must completes the form below and submits their information,   New clients  will receive an email inviting him/her to create an account and password at Carepatron the telehealth portal. If you do not receive an email invitation within 24 hours of your request, send an email to

 Check your spam folder for the  Carepatron telehealth portal invitation. When your appointment is scheduled you will receive text messages and email reminders to confirm the appointment. 

Current clients please  use the form below to schedule an appointment by adding the day and time preference on the form. 


Free 15 minute phone or video consultation available for new clients.


Master Card, Visa, Discover, American Express, Medical FSA, HSA and EAP payments are accepted.

Once your appointment is scheduled and you confirm via email you will be directed to 

the telehealth portal, Carepatron. You can pay for your session prior to your appointment 

when you log into the therapy session portal.

Invoices are provided for your convenience to apply them toward your insurance deductible or copay expenses.

Therapist do not accept insurance at this time.  We do accept Employee Assistance Programs (EAP), credit and debit MasterCard, Visa, Discover, American Express, FSA & HSA insurance cards.

*Important, please read the cancellation and no show policy to the right of tis page.  

If this is an "emergency" therapy request, please call your nearest hospital emergency room or dial 911 for assistance.  Please do not wait to be contacted by a therapist as we cannot manage your emergency situation. 

If you are feeling suicidal dial #988

New Client Therapy Request Form


Cancellation policy

Cancellation- Clients are required to text or email their therapist within 24 hours of their appointment to prevent a $35.00 late cancel fee.

No Show- Clients who no show for a scheduled session will be assessed a $35.00 fee.

Incurred fees- Clients who incur fees must pay them prior to scheduling another appointment.

Subscription -Counseling is not offered by subscription. Each session is paid following your therapy session at Carepatron through Stripe a payment processing platform that accepts credit & debit MasterCard, Visa, American Express, Discover, HSA and FSA insurance cards.

Contact Information

Phone / Text 734.968.0218

Fax- 734.884.5001