Name *

First Name

Last Name

Phone *

(###)

###

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Services *

I'm interested in services for:

Individual Psychotherapy

Eating Disorder Therapy

Neurodivergent-Affirming Therapy

Narcissistic Abuse Recovery Therapy

Therapy for Therapists

Supervision

Something else

Fees *

I understand that Healing Pathways Collaborative LLC is an out-of-network provider. I am aware that I will be responsible for paying the full fee at the time of service and may pursue reimbursement from my insurance company depending on my coverage and benefits.

Yes