Name *

First Name

Last Name

Phone *

(###)

###

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Out of Network *

I understand that Dr. Rachel does not accept insurance and am able and willing to pay the session fees out of pocket.

Yes

Telehealth *

I understand that all of Dr. Rachel's sessions are conducted virtually.

Yes

Appointment availability

I understand that Dr. Rachel sees clients on weekdays only and her last appointment starts at 3pm Central Time.

Yes