Hue and Healing Family Therapy, Inc.

Who would be receiving care?

My partner and me

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Pronouns

I understand I have to be a California resident and physically located in California to receive therapy services at Hue & Healing.

Yes

Administrative

How did you hear about us at Hue & Healing Family Therapy, Inc.

I understand consultations are for private practice services only and not for third-party platforms (e.g., Grow Therapy)

Yes

Client Preferences

Therapy sessions are scheduled Monday - Thursday between 10:00AM - 6:00PM

When are you typically available for therapy? Ex. Tuesdays from 10am-12pm or Thursdays between 3pm-6pm. Please be as specific as you can.

Limited to 600 characters

I understand that Hue & Healing does not have in person availability and would be willing to proceed with virtual therapy.

Yes No

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.