Our Contact form is the fastest way to reach us! A member of our team will reach back out to you as soon as possible.

Please note that all of our clinicians are licensed in Pennsylvania only. We are only permitted to provide clinical therapeutic services to individuals who are physically located in the state of Pennsylvania at the time of service.

Name

Email Address

Phone Number

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. Feel free to provide additional information at the bottom of the form.) Please Indicate the Treatment Specialties you are interested in. (Check all that apply. Feel free to provide additional information at the bottom of the form.) 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

Please indicate your preferred provider, if any. (We'll do our best to match you with your preferred provider, but may make another suggestion based on scheduling or insurance compatibility.)

Please check whether you are open to in-person and/or virtual sessions. (If you have a strong preference, you may include that information in the Additional Information section below.) Please check whether you are open to in-person and/or virtual sessions. (If you have a strong preference, you may include that information in the Additional Information section below.) VIRTUAL IN-PERSON

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, UPMC for LIFE, 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, UPMC for LIFE, etc. All other insurances are considered out of pocket. Highmark (or other Blue Cross/Blue Shield plans) UPMC Commercial Plan (not UPMC for you) Aetna Cigna 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.

By entering your email and phone number into our contact form, you consent to receive an email message or phone call from Untethered Therapy regarding scheduling for mental health counseling services.