Name *

First
Last

Phone *

By providing my phone number, I agree to receive text messages and calls from Zeeva.

Email *

Date Of Birth*

Month

Day

Year

I am looking for therapy for

Myself

My Child

Couples or Family

Someone else

Child's Name

First
Last

Potential Clients's Name

First
Last

Child's Date of Birth

Month

Day

Year

Is there a custody agreement where both parents share medical decisions for the child?

Yes

When billing your insurance for couples therapy we are required to perform an initial intake assessment with the person who's insurance we are billing before couples sessions may begin. We are required to assess for medical necessity before seeing both parties. What this means is the insurance holder will attend the first session alone to meet with the therapist.