IN-HOME THERAPY SESSION

First Name

Last Name

Phone *

Email *

Address

Street Address

City

State

Country

Postal Code

Reason for In-Home Request *

I understand that in-home therapy sessions are not standard appointments, are subject to clinical discretion, and may involve different fee structures than office or telehealth sessions.

I understand that submission of this request does not guarantee approval or availability.

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About In-Home Therapy Sessions

In-home therapy sessions are offered on a limited, approval-only basis for clients who require enhanced privacy, extended session time, or specific clinical accommodations.

These sessions are not directly bookable and are reviewed individually to ensure clinical appropriateness, safety, and scheduling availability.

By submitting this request, you are asking Melissa to personally review whether an in-home session is a good fit for your needs. If approved, she will contact you directly to discuss next steps, availability, and session details.

Submitting this form does not guarantee approval or availability.