First Name
*
Last Name
*
What are your pronouns?
Date of Birth
Email
*
Phone
*
How did you hear about us?
*
Instagram
Google Search
TFW Podcast
Amanda's Podcast
Yelp
Friend
Facebook
Another Helping Professional
Tiktok
Psychology Today
Another Podcast
I don't know
Other
No elements found. Consider changing the search query.
List is empty.
If you selected "Other" above, where?
Tell us about what you're dealing with...
What services are you interested in?
*
Individual Therapy
EMDR
Low Fee Therapy with an Intern
Couples Counseling
Family Therapy
Medication Management/ Psychiatric Evaluation
Nutritional Counseling
Other
If you checked "Other" above, what other service are you interested in?
Is there a specific therapist you are interested in seeing? Feel free to tell us anything to help us match you with a therapist.
Choose the availabilities that apply
*
Monday 8-11am
Monday 12-5pm
Monday 5-8pm
Tuesday 8-11am
Tuesday 12-5pm
Tuesday 5-8pm
Wednesday 8-11am
Wednesday 12-5pm
Wednesday 5-8pm
Thursday 8-11am
Thursday 12-5pm
Thursday 5-8pm
Friday 8-11am
Friday 12-5pm
Friday 5-8pm
Saturday 8-11am
Saturday 12-5pm
Saturday 5-8pm
No elements found. Consider changing the search query.
List is empty.
I would prefer if my therapist is...
No preference
Female
Non-binary
LGBTQ+
BIPOC
What office are you interested in?
*
Teletherapy only
In Person Old City
In Person Center City
In Person Main Line
Any Office in Person
Philly or Virtual
Main Line or Virtual
Any Option
No elements found. Consider changing the search query.
List is empty.
If in person isn't available, are you comfortable being virtual?
*
Yes
Yes, but only temporarily. I want to eventually be seen in person.
No, I only want in person therapy
What state do you live?
*
How would you like us to contact you?
*
Email
Text
Phone Call
No Preference
SUBMIT