Please enter your information below. If you are inquiring about services for your child, please enter their name.

First Name
 

Last Name


Date of Birth (mm/dd/yyyy)   
   

Email   


Phone   

Spencer Psychology uses a texting service to notify clients when an appointment is available. Please be sure to include your cell number as your permission for us to contact you through text, as your “opt-in”. We do not use your number for any other purpose than scheduling, and you may opt-out at any point by notifying us.

I will be using insurance as part of my payment:  
Do you have a preference for type of appointment? (if no preference, please skip)


  • Tech support is available if you need help.
  • If you can use streaming services (Netflix, Zoom) on your computer or phone, you will have the internet bandwidth for a good telehealth connection.
  • If your internet connection struggles to stream smoothly, you’ll want to have in-person sessions.
I am a:   

Are you seeking any of these specific services?









Reason for seeking therapy:   
In order to match you to a therapist, please tell us the reason you are seeking therapy, and what symptoms you are struggling with (i.e. depression, stress, anxiety, OCD, trauma, etc). The more detail you can give, the better we can match you.

How did you hear about us?