Schedule an Appointment Please fill out the following form to schedule an appointment. Due to high demand, we will contact you as soon as we have an appointment available. Please note: some of our therapists are currently on a waitlist. If an appointment is not available, we will put you on the wait list for for all preferences indicated. What brings you here today? Select an option Individual Counseling Group Counseling Both Individual and Group Relationship Counseling Family Counseling
Gender assigned at birth (Note: for insurence purposes only)?
Due to state licensure and professional practice requirements, we can only take clients living and/or residing in the state of Massachusetts.
Do you currently live and reside in Massachusetts?
Type of service needed Choose an option Individual Therapy Couples Therapy Family Therapy Intuitive Eating Group Trans and Non-Binary Group Eating Disorder Support Group
If signing up for group, are you also interested in individual counseling?
If preferred clinician is not available, do you have a second preference?
Prefered method of payment Choose an option Private Pay BlueCross BlueShield Cigna Tufts Beacon Health - Commercial Beacon Health - MassHealth Harvard Pilgram United Health Plan Optum Health Always Health Partners Other Insurance Please Note: If planning to pay using your health insurance carrier, please be advised that most insurances will have either a deductible or co-payment. If you have any questions regarding co-payments or deductibles, please contact your insurance carrier by calling the number on the back of your insurance card.
Why did you decide to seek counselng?
Do you currently have a Primary Care Physician?
Are you currently suffering from a medical condition, illness, or injury?
Have you been hospitalized in the last 12 months?
How did you hear about Reimagine Counseling? Choose an option Behavioral Health Provider Friend/Coworker Google/Web Search Health Professional (i.e. Counselor, Dietitian, Psychiatrist) InnoPsych Insurance Provider Intuitive Eating Registry Primary Care Physician Psychology Today State Agency (i.e. DMH, DCF, DDS) Therapy for Black Men Therapy for Black Girls Therapy for Latinx William James Interface Other Referral Source I declare that the info I’ve provided is accurate & complete Submit Additional Notes