Name
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First Name
Last Name
Phone
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(###)
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Email Address
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I am interested in:
Please select the service or psychotherapist you are interested in contacting.
I would like to see:
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Select the practitioner who you are interested in.
How did you hear about us?
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How did you learn about Boketto Center?
What type of insurance do you have? (Please list ALL insurances you have regardless of if we take that plan)
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Please select your insurance carrier(s) or if you will be private pay.
Do you have secondary insurance?
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Do you have more than one insurance carrier?
What days and times are you available for therapy on a weekly basis?
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We see people mostly weekly for therapy. Please let us know what times work best for you on a regular basis.
Best contact method for scheduling:
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*If you do not hear back from us, please check your spam folder and/or reach back out. Rarely, there are issues in message retrieval.
Would you prefer in-person or telehealth sessions?
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How can we help you?
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Please let us know what you're looking for help with so we can match you with the best clinician.
On a scale from 0-10 how ready are you to start therapy?
0 being not ready at all, and 10 being you're fully ready and committed to the therapeutic process.
Do you currently reside in Michigan?
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You must physically be in Michigan during your psychotherapy appointments.
