We're excited about meeting you!  

This form is used for new and *returning clients to request an appointment to make scheduling easy and effortless!  This pertinent form let's us gather basic information, insurance information, and it is used to briefly identify the reasons a prospect client is interested in counseling, if an appropriate client-clinician match, we will both register you as a client, and verify your outpatient mental health benefits. 

What happens next? 

Upon receipt of your APPOINTMENT REQUEST FORM, we will promptly review you submission.  If prospect client is not a match we will provide referrals.   If an appropriate client-clinician match, subsequently we will provide you will a Good Faith Estimate of the expected cost of your therapy services i.e. cost of Intake Session(s) and cost of Ongoing Therapy Session(s), ect. 

Simply, Reply back "C" to Welcome Message with Good Faith Estimate to Confirm Appointment and or we may send Good Faith Estimates via an e-mail for clients to review and sign off on.  

Thank you,

The Pink Positive Psychology Team

*Returning clients are previous clients that have not been seen for more than 2-months. 

Thank you,

The Pink Positive Psychology Team

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*This form is HIPPA compliant and ENCRYPTED which means your information is safe and secure.