— Eleanor Roosevelt

Therapy Contact Form

Completing the form is the best way to get started as a prospective therapy client.

2002 Atwood Avenue, Suite 224
Madison, WI

Allison@StrengthsFocusedTherapy.com

608-879-5393

Name and pronouns

Phone

Age Range

Services

Referral Source

I'm looking for a provider who can... and support me with...

Payment options * Required

Anthem/BCBS

Dean

GHC

Medicaid - Check HMO if relevant

Medicare - Check HMO if relevant

Quartz

UHC/UMR

Other insurance company

Out-of-network/using superbills

Pay for sessions privately

Time of Day Availability * Required

Any time of day - highly flexible

Mornings 9-12pm

Afternoons 1-4pm

Only after 4pm

Day of the Week Availability * Required

Monday

Tuesday

Thursday

Friday

Session Format * Required

I prefer in-office sessions.

I prefer online sessions.

I require online sessions due to living elsewhere in Wisconsin.

Session Frequency * Required

Weekly

Every other week

Once a month

I require a fully accessible building for services; I am not comfortable using stairs.

Consultation Phone Call

Thank you for reaching out! I'll be in touch within a week. Sometimes my replies get caught in your spam folder; I reply to every client contact!

Strengths-Focused Therapy, LLC

608-879-5393

Allison@StrengthsFocusedTherapy.com

Mondays, Fridays: 9am-4pm. Tuesdays, Thursdays: 10am-5pm

2002 Atwood Avenue, Suite 224
Madison, WI

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