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Ready to start your healing journey? Contact me today to schedule your session.

info@alternativehealinglc.com

225-351-7262

New Client Screening

Name of potential client*

Client's date of birth*

Email Address*

Phone*

Reason for seeking services?*

How would you prefer to communicate *

Text (fastest response)

Phone Call

Service Type*

Individual/Couples Therapy

Wellness Coaching

Private Events/Workshops

Business Coaching/Consultation

Community Outreach

Method of payment (therapy is the only service covered by insurance)

Private Pay

Aetna Commercial

Blue Cross Blue Shield

Cigna

United Healthcare/Optum Commercial

Residential Location (if applicable, for therapy only)

Louisiana

Texas

How did you hear about us?*

Internet Search

Google Search

Referral from a friend

Referral from a professional

Psychology today

Insurance company website or directory

Select an option *

I understand that all sessions are via telehealth

I am not interested in telehealth. Please disregard this submission.

Select an option*

I understand that all appointments will be between 7:00am-3:00pm.

Appointments between 7:00am- 3:00pm will not work for me. Please disregard or reach out with additional options.

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Disclaimer:

The contents of the Alternative Healing LLC (hereinafter referred to as “Alternative Healing”) media platforms (to include, but not limited to website, Instagram, Facebook, TikTok, Twitter), such as text, graphics, images, and other material contained on the Alternative Healing media platforms ("content") are for informational purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your mental health professional or other qualified health provider with any questions you may have regarding your condition. Never disregard professional advice or delay in seeking it because of something you have read on the Alternative Healing media platforms.

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Contact Information

225-351-7262

info@alternativehealinglc.com