PRO TIP:  Take Pictures of Drivers License/ID (front & back) & Health Insurance Card/s (front & back) BEFORE filling out this form. 

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*Request My Appointment & Verify My Insurance Form

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Upon receipt of your form I’ll personally send you your Welcome Message - your simple roadmap for getting started. Inside, you’ll find:​📅 Your Intake Appointment Date & Time✅ Your Benefits Quote / Good Faith Estimate📝 Your Quick Digital Intake Forms & Assessments🔗 Your Instant Virtual Waiting Room Link - just tap when it’s time. No downloads. No tech stress. Simply reply “C” to Your Welcome Message to confirm Your Intake Appointment. Yes, scheduling it's really that simple!💫 Melissa E. Mendoza, LMSW📍MI

 

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*If not a match we will provide referrals.

**No obligation or cancellation fees if you decide not to proceed with the session based on the provided benefits quote.

***All Forms are Mobile Friendly / Electronic Forms that are HIPPA compliant and ENCRYPTED which means your information is safe and secure.