Somatic Therapy with Katie

• Name*
  First Last
• Email*
• Phone #*
• Date of Birth*
  MM slash DD slash YYYY
  We ask for your date of birth to help expedite the verification process with insurance companies.
• Self Pay Rate*
  • Self Pay $45 per session
  This service is not eligible for insurance reimbursement.
• What day(s) of the week work best for scheduling?*
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • No preference
• What time(s) of day works best for scheduling? Please be advised that evening time appointments are limited. Please indicate if you have any daytime flexibility with your weekday schedule. Thank you.*
  • Before Noon
  • Between 12-4pm
  • After 4pm
• Do you have a preference between in person or telehealth therapy sessions?*
  • In person only
  • Telehealth only
  • Mix of both
  • No preference
• Are you interested in any other services Elle offers?*
  • Nutrition for Eating Disorder Support
  • General Nutrition Needs
  • EMDR
  • Brainspotting
  • Somatic Group Therapy
  • Body Acceptance Group
  • Not at this time, thank you.
• How did you hear about us?*
  • Google
  • Facebook
  • Instagram
  • Psychology Today
  • From another publication on the web
  • From a family member or friend
  • From someone who works at Elle
  • From another healthcare provider
  • Other
• Other comments*
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