Join the Waitlist for Therapy Services

Psychotherapy services have an 8-week wait for BCBS members. Submit the form to hold your place and we’ll contact you when available.

Psychotherapy Client Wait List

Please fill out our HIPAA compliant wait list form. Our Support Team can contact you when we have openings. Please be advised that we may have a 4-5 week wait period for BCBS members seeking psychotherapy services.

Please enter your first name.
This field is required.
Please enter your last name.
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Please enter the prospective client’s first name.
This field is required.
Please enter the prospective client’s last name.
This field is required.
Date of Birth of Person who is seeking services
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Please enter your phone number in area code and number format.
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Please select the type of service you are requesting.
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Insurance Provider
Please select your insurance provider.
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Please insurance provider name
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Briefly Describe why you are seeking therapy services
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History

Have you previously received mental health or psychotherapy services?
This field is required.
Please Provide the relevant detail
Have you ever been hospitalized for psychiatric issues?
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Please Provide the relevant detail
Have you ever had or are currently experiencing thoughts of suicide?
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Please Provide the relevant detail

General Information

Are you currently taking prescription medication?
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Please Provide the relevant detail
In a few sentences, please describe why you are seeking therapy services at this time.
How did you hear about us?
Please Specify
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