Request appointment | Aligned and Refined Mind Psychotherapy, LLC

Referral source - How did you find me?

Psychology Today Alma Headway Therapy Den Referred by PCP Referred by Psychiatric Provider Referred by another therapist Referred by a family member Referred by a friend Google Search No referral Aligned and Refined Mind Website

Driver's license upload

Do not upload sensitive financial information such as credit card information.

IMPORTANT: After submitting this form, your information will be reviewed to determine whether I may be a good fit for your needs. You will then receive an approval or denial message through the secure SimplePractice client portal. If approved, you will be asked to complete new-client paperwork through the portal. This step is required in order to verify insurance benefits and move forward with scheduling. Once the paperwork is completed, you will be able to select an available appointment time through the SimplePractice client portal.

Driver's License or State ID is required to be uploaded to verify your identity & to comply with state Telehealth laws.

I understand that completion of new client paperwork is required prior to scheduling. I don't wish to move forward with scheduling

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