New Clients

Name(required)

Phone(required)

Email(required)

Can Tracy Lamperti text you at the number you provided? (The text will say, "Tracy Lamperti has replied to your inquiry. Please check your spam if you did not receive it.")(required)

Seeking therapy for;(required)

Myself (adult individual) My Marriage My Family Concerns about my child/child in my care.

What is your insurance?(required)

In what state do you reside?(required)

Do you require an appointment time at 4pm or later (very limited availability)? (required)

Yes Ideally but if necessary I can meet earlier in the day. No

All sessions being offered are Telehealth;(required)

Yes, I understand.

Are you involved in any agency or circumstance which may require you to provide information about your counseling attendance?(required)

As a general policy, Tracy Lamperti does not write letters. If you require treatment verification, you will be provided with a statement of dates of services. Please see the HIPPA law for more information about your confidentiality and how the integrity of your privacy and records is maintained.(required)

By checking this box, I acknowlegde that Tracy Lamperti will not provide me with a letter, be it for purposes of; legal, housing, employment, disability, citizenship, school, or other.

How did you hear about Tracy Lamperti's services? If referred by someone, please include their name.(required)

Have you browsed around Tracy Lamperti's website, read a few blog posts, etc. to receive a sense of whether she seems like a therapist you could work well with?(required)

Yes No I will do so now.

Message (Please share a brief summary of why you are seeking counseling.)(required)

Self-help (In light of the current shortage of professional counseling services, please share what you are doing while you are looking and waiting for an appointment, to address the reasons for which you are seeking counseling.) (required)

Are you open to considering one of Tracy's self-help programs while you are waiting for your time to come up on Tracy's waitlist (wait times could be 4 weeks to 3 months)? (required)

No thank you, I will wait. Yes, I would like to look them over and consider getting started on my own, while I am waiting.

Thank you for sharing this information. Tracy Lamperti will contact you within 2 business days.

New Clients

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