Contact us for an appointment

What type of appointment would you like to schedule?*
IndividualCouplesFamilyMinor (11-18)Minor (7-11)

Would you like to schedule for virtual or in person?*
in personvideo appointmentseither

Your Name*

Your Email*

Guardian Name(s) if client is under 18, N/A if 18+ - if for couples therapy provide partner's name*

Your Phone Number*

Your Insurance information*
SHIPAnthem Blue Cross (not the same as Blue Shield)Medicare (not the same as Medi-Cal, or Medicare Advantage)Out of Network/PPOPrivate PayOther

Your insurance ID and group number (This helps us verify benefits. It may contain letters and numbers)

Please upload a copy of the front and back of your insurance card*

Patient Date of Birth*

Do you have a therapist preference?
—Please choose an option—Brian Sedgeley, PsyDKristy Shanks, LCSWHelen Veazey, MAMarisa Gordon, LMFT

Additional information*