Please fill out the Initial Client Form below to schedule your free 10-minute initial phone consultation. Contact Us Contact Us First Name * Last Name * Email * Phone * Are you interested in a free 10 minute phone consultation? Yes No Are you interested in virtual or in-person sessions? * Online therapy (also known as "Teletherapy") In-person (when we are allowed to do so) No preference How will you pay for therapy? Private Pay Using Out of Network Benefits Would like to discuss a reduced rate OtherOther Embracing Joy is an out-of-network provider. I am aware that Embracing Joy Marriage and Family Therapy is an out of network provider. * Yes What are some reasons you are seeking therapy right now? * Have you sought therapy in the past? (If so, was there anything negative or positive you experienced in that treatment?) * Have you ever had mental health emergencies in the past? (Crises such as: panic attacks, debilitating depression, suicidal feelings and/or attempts, any hospitalizations for mental health? If so, how long ago and what was the treatment for it?) * What time would be best in your schedule to meet for therapy? * What would be the best style of communication for you when speaking with your therapist? * A more direct/challenging approach A collaborative/supportive approach No preference Is there a specific therapist you would prefer to work with? * No preference Maryann Rulapaugh, LMFT Mariam Torosyan, MFTi Somer Saleh, LMFT Hazel Sherin, MFT Associate What state do you live in? * How were you referred to our practice? * Is there anything else you would like us to know about you? Any other questions for us? Prior to visiting our website, we would love to know how you first learned of us? Google Instagram Facebook LinkedIn Newsletter Friend Professional referral OtherOther Would you like to receive email updates? Yes No We look forward to connecting with you shortly. *Please add intake@embracingjoy.com to your address book so a confirmation email to schedule your consultation will not go to your spam folder. If you are human, leave this field blank. Submit
