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Please Indicate the services you are seeking. (check all that apply) Please Indicate the services you are seeking. (check all that apply) INDIVIDUAL THERAPY COUPLES THERAPY CHILD/ADOLESCENT THERAPY FAMILY THERAPY GROUP THERAPY NEUROTHERAPY TRAUMA INTENSIVE COUPLES INTENSIVE CLINICAL SUPERVISION / CONSULTATION

Please Indicate the Treatment Specialties you are interested in. (check all that apply) Please Indicate the Treatment Specialties you are interested in. (check all that apply) Trauma (PTSD, Accident, Abuse, Neglect etc.) Depression, Anxiety, Stress Infidelity/Betrayal Trauma Behavior Addiction (Sex, Technology, Gaming, Gambling) Chemical Addiction Grief/Loss Parenting Infertility/Adoption/Foster Care

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Please indicate the days and times you are generally available for appointments. The more flexible you are with your options, the quicker you are likely to be connected with services.

Please indicate the payment option you plan to utilize. We are in network with the insurances listed below, although there is some variability by providers. We are not in network with any state-funded health insurances such as Medicare, Medicaid, UPMC for YOU etc. All other insurances are considered out of pocket. Please indicate the payment option you plan to utilize. We are in network with the insurances listed below, although there is some variability by providers. We are not in network with any state-funded health insurances such as Medicare, Medicaid, UPMC for YOU etc. All other insurances are considered out of pocket. Highmark Blue Cross/Blue Shield UPMC Commercial Plan (not UPMC for you) Aetna United Healthcare (Optum) Out of Network (OON)

Please share any additional information that will help us connect you with the provider who would be the best fit for you.