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 is your primary insurance?
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Please select your insurance carrier(s) or if you will be private pay.
Do you have secondary insurance or any other insurances? Failure to report this can result in services not being covered.
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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.
I consent to being contacting for scheduling through the following forms of communication.
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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.
