Free 30-Min Consultation | Sarah Miller Psychotherapy

Welcome

I offer a FREE 30-minute consultation to make sure my practice is the best fit for you before we begin our work together.

Your responses will help me to understand how to best serve your needs so we can start the healing process together.

Please take a moment to fill out the information in this form.

What is your name (first & last)?

What are your preferred pronouns (he/him, she/her, they/them, etc.)?

What is your phone number?

What is your email address?

Where are you located (city & state)?

How did you hear about me?

Therapy will most likely require a commitment of 1 weekly meeting of 50 minutes each. These meetings will be scheduled on weekdays and will be in addition to any other family and work obligations you may already have. *PLEASE CONFIRM YOUR UNDERSTANDING & AGREEMENT TO THIS POLICY

Individual Therapy will require an investment of $180 per 50-minute session. Couples Therapy will require an investment of $215 per 60-minute session. Group Therapy rates vary on the type of therapy provided and the number of participants. These rates are subject to change annually. * PLEASE CONFIRM YOUR UNDERSTANDING & AGREEMENT TO THIS POLICY

You will be required to keep valid billing information on file on our secure, HIPAA-compliant patient portal. You will automatically be charged on the day of your session. In accordance with the Cancellation Policy, you will also be charged on the day of your canceled/missed session. * PLEASE CONFIRM YOUR UNDERSTANDING & AGREEMENT TO THIS POLICY

My practice requires 48-hour notice for cancellations or schedule changes. For any session canceled with less than 48-hour notice, you must reschedule within the same calendar week (subject to availability) or be automatically charged in full. * PLEASE CONFIRM YOUR UNDERSTANDING & AGREEMENT TO THIS POLICY

What caused you to make this inquiry with me?

What are your goals for our work together?

Are you looking for in-person or virtual therapy sessions?

Are you looking for individual, couples or group therapy?

Please write in your general availability (weekdays and times).

Is there any information you need to know about me before we begin?

Disclaimer and privacy policy acknowledgment

I offer a FREE 30-minute consultation to make sure my practice is the best fit for you before we begin our work together.

Please take a moment to fill out the information in this form.

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