Booking at Emotions In Harmony

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Have you had an appointment with us before?* This field is required.

No, this is the first time I am scheduling

Yes, I have already registered

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Type of Service* This field is required.Our prices are in US Dollars

Individual Therapy = $265

Couples Therapy = $285

Family Therapy = $285

Immigration Evaluation = $2,215

Life Coaching

3

Legal Name* This field is required.

First Name

Last Name

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Chosen Name* This field is required.

First Name

Last Name

5

Gender* This field is required.Example: Man / Non-Binary / Transgender / Woman

6

Date of Birth* This field is required.

Date

7

Phone Number* This field is required.

Area Code

Phone Number

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E-mail* This field is required.

example@example.com

Confirm Email

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Your Partner's Information* This field is required.

First Name

Last Name

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Your Partner's Phone Number* This field is required.

Area Code

Phone Number

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Your Partner's Email* This field is required.

example@example.com

Confirm Email

12

Do you live in California (USA) or in Mexico?* This field is required.Click "NO" if you belong to a country other than the mentioned below.

YesNo, I live in another country

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Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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How did you hear about us?* This field is required.

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Through what other method did you hear about us?* This field is required.

16

Do you want to book the appointment by yourself?* This field is required.

Yes

No, please contact me

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In which language would you like to have your session?* This field is required.

English

Spanish

Both are fine for me

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Therapy Modality* This field is required.

In Person

Online

Both are fine for me

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Your psychologist is ready to serve you!* This field is required.

Dr. Carmen Román

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Which psychologist do you prefer? Both are ready to serve you!* This field is required.

Dr. Liz Caine

Dr. Carmen Román

Please assign me one

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NO BORRAR, USAR EN CASO DE UN NUEVO PSICÓLOGO... Which psychologist do you prefer? They are both fully bilingual!* This field is required.

Dr. Carmen Román

Ana Valle, LMFT

Please assign me one

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Coaching services are available in SPANISH ONLY for now.
Sessions are virtual via Zoom.

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Choice of Payment* This field is required.If you pay for the 12 sessions in a single payment you will receive a discount, saving $84.

Individual (per session) = $112

Total Payment (12 sessions for $105) = $1,260

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Our coach is ready to work with you!* This field is required.

Rosa Estela Mendoza M.S.

25

Do you want to subscribe to our Newsletter?* This field is required.Through this medium you will receive our free content

Yes, I want receive the content for free!

No, I'll subscribe later

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