New Client Therapy Request Form
New clients please read - New clients must complete the form below and submit their information, Once the form is submitted, you will receive an email from Louise Dery, LMSW with instructions on how to create your account and password at the telehealth portal. If you do not receive an email invitation within 24 hours of your request, send me an email or text message to info@louisederylmsw.com . New patients can request a free 15 minute phone or video session to be sure online therapy is right for you.
Check your spam folder for the telehealth portal invitation. When your appointment is scheduled you will receive text messages and email reminders to be sure you don't miss your appointment.
Once you receive the invitation to the portal, please complete the information and sign important documents (Notice of Privacy Practice, Consent For Treatment etc.) and we can get you started whether you are paying cash or using your insurance.
Therapy Session Payments Accept-
Medical FSA & HSA Cards and Employee Assistance (EAP), Cash rate and Insurance
Please call to inquire if your insurance is accepted.
Once your appointment is scheduled, you will be directed to the telehealth portal to create an account. After your initial appointment, you can come to the website and schedule follow up appointments or make them with me during your session.
*Important, please read the cancellation and no show policy to the right of tis page.
THERAPY FORM REQUEST
Cancellation policy & Scheduling
• Cancellation- Clients are required to text or email to cancel their scheduled appointment within 24 hours of the appointment day and time. This will prevent a late cancel fee, which is the same amount as the session fee.
• No Show- Clients who no show for a scheduled session will also pay the fee equal to the session fee. .
• Clients Pay In Advance - Clients pay in advance to secure their preferred appointment day and time. They may cancel and use the payment for another appointment, but it must be within 2 weeks of the cancellation This does not apply to no show. Client must cancel and reschedule within 24 hours of original appointment.
• Subscription & Scheduling Appointments- Counseling is not offered by subscription. Each session is paid in advance of your therapy session to secure your preferred day and time.
Stripe a payment processing platform that accepts credit & debit MasterCard, Visa, American Express, Discover, HSA and FSA insurance cards.
Go to the "Meet The Therapist" page, click the "schedule an appointment" link to be directed to my calendar.
Contact Information
•Main Phone & Text 734.968.0218
•Fax- 734.884.5001
•Email- info@louisederylmsw.com
EMERGENCY
Please, call your local hospital emergency room or
DIAL 911 for assistance with your emergency.
If you are feeling sucidial
DIAL 988
Or click the link below
