Munro Psychotherapy PC | SimplePractice

Munro Psychotherapy PC Send Message

Your info

First name

Last name

Email

Phone

Name you go by

Date of birth

State

Select the state you live in

Reason for care

What is the reason for seeking care?

Anxiety ADHD Addiction Depression Substance use Other

What kind of care is being sought?

Please note that I do not prescribe medication or provide couples or family therapy.

Individual Psychotherapy Other

Administrative

Inquiry reason

Referral source

How did you hear about me?

Google search Someone referred me Directory (i.e. Psychology Today, Mental Health Match) Other

Billing & Payment

Payment method

How do you plan to pay for sessions?

Statement about insurance

I do not work directly with insurance. My session fee is $200. Please indicate that you understand that I am out-of-network and will not be submitting claims or otherwise interacting with insurance on your behalf.

Client Preferences

Preferred modality

How would you like to meet?

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice.