Please enter your information below. If you are inquiring about services for your child, please enter their name.
Legal First Name
*
Legal Last Name
*
Preferred Name (if different than legal)
Date of Birth (mm/dd/yyyy)
*
Please enter a valid date
Email
*
Please enter a valid email address
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:
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Yes
No
Do you have a preference for type of appointment? (if no preference, please skip)
In-Person
TeleHealth
I am a:
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New client
Previous client or a family member has been a client
Are you seeking treament for any of these specific symptoms, issues, or services?
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.
EMDR
Substance Abuse
Trauma
Anxiety-Depression
Autism Spectrum
Eating Disorder
Art and Expressive Arts
OCD
Child aggression-defiance
Self-harm (such as cutting)
Suicidal thoughts
Couples Counseling (self pay)
DBT (Individual)
DBT Group (adults)*
DBT Group Teen Girls (ages 14-19)
EMDR Intensive
Cultural-Racial
LBGTQ+
Christian Counseling
Reason for seeking therapy:
*
If you are currently seeing a therapist, please describe in the box above. This will help us in matching one of our therapists with you.
How did you hear about us?
This Contact Form is not monitored in real time. Do not use in crisis situations.
If you are in crisis,
visit our crisis information page to see options.