Please enable JavaScript in your browser to complete this form.12Client Name *FirstLastEmail *Phone Number # *Office Location *Leominster, MAIndianapolis, INKissimmee, FlServices Needed *Individual TherapyFamily CounselingGroup TherapyCouples TherapyAnimal Assisted TherapySession Type *In PersonTelehealthBoth – HybridInsurance ProviderPolicy NumberPolicy Holder's NameFirstLastNextWhy are you seeking therapy? *I am depressedI feel anxious/overwelmedI’ve been diagnosed with a mental disorderI’m struggling with relationshipsI experienced traumaI am grievingI want to improve self confidenceI am battling addictionRecommended (by doctor, family or friends)OtherPreviousSubmit