*REQUEST MY APPOINTMENT WITH MELISSA

TIP: BEFORE filling out this form take a picture of the front and back of both your insurance card and drivers license. 

For all *Prospective Clients and Returning Clients, please fill out this 5-minute form to assists us in understanding your treatment needs, ensuring an optimal client-clinician match.  It also captures your scheduling preferences and health insurance information so we can promptly provide you with a Benefits Quote and necessary Intake Form/s to schedule your Intake Appointment accordingly.  

WHAT HAPPENS NEXT?

You'll receive a Welcome Message with:

• Your Intake Appointment Details (i.e. Day / Time)
• Benefits Quote or "Good Faith" Estimate
• Intake Forms
• Link to Clinician's Virtual Waiting Room 

To confirm the Intake Appointment, simply reply with "C".

Thank you, 

      Pink Positive Psychology Team

*All Forms are Mobile Friendly / Electronic Forms that are HIPPA compliant and ENCRYPTED which means your information is safe and secure.