Therapy Modality Selection Form
Choose the therapy approach that best fits your needs.
Full Name
First Name
Last Name
Email Address
example@example.com
What brings you to therapy? (Briefly describe your main goals or concerns)
Which therapy modality are you most interested in?
*
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Psychodynamic Therapy
Humanistic Therapy
Acceptance and Commitment Therapy (ACT)
Solution-Focused Brief Therapy
Other
How would you prefer to attend therapy sessions?
In person
Online (video/telehealth)
No preference
What is your preferred session frequency?
Weekly
Bi-weekly
Monthly
Other
Would you like to be matched with a specific type of therapist?
Male therapist
Female therapist
No preference
Is there anything else you’d like to share about your preferences or needs?
Submit
Should be Empty: