Contact Us Open Form Applying for Therapy If all/my chosen therapist(s) is/are currently full, I would like to... * Be sent referrals for other therapists Be placed on a wait-list for Connection Counseling Work with a Master’s level intern who is supervised by April Name * First Name Last Name Email * Phone Number I am seeking therapy for... * Myself My Child My Family My Spouse I was referred by A provider A school An internet search Other Provider/School/Other... I would categorize the needs I’m seeking support for as * Adult Autism Evaluation Outpatient therapy (in person) Outpatient therapy (virtual) One on one support for my child outside of the home (school/community) Parent support/coaching Education about autism related to a member of my family Group Therapy (Gaming group for adolescents) Group Therapy (Dungeons & Dragons group for high schoolers) Group Therapy (Outings group for adolescents/teens) Group Therapy (Art group for 8-11 year olds) I would categorize the needs I’m seeking support for as * Autism ADHD Neurodiversity Executive functioning Relationships Gender identity LGBTQ+ issues Life transitions Life skills Stress Anxiety Depression Trauma I am hoping to pay by * Insurance only Private pay only Insurance OR Private pay Free therapy provided by an intern Please include the specific type of insurance coverage you would like to use Please let us know when you or your child would be available to receive support * I am seeking therapy from... * *Note that we will do our best to connect you with your preferred therapist. Based on availability, we may need to refer you to another therapist. Additional Message (Optional) Thank you!
