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Second Nature Counseling

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The application below is a tool I use to gather information to ensure I am a good fit for you. Rest assured your answers are private; please be as open as you feel comfortable answering these questions.

After you have completed this application, we will review your answers and contact you regarding packages and pricing. We accept cash and several types of insurance.

Application

First Name

Last Name

Phone

Gender & Assigned Sex at Birth

Please select which option applies. *

I'm seeking out counseling for myself.

I'm filling this form out for a child, and am a parent or legal guardian.

I'm filling out this form for myself and my partner (couples therapy)

What prompted you to seek out counseling today?

Please mark the areas you'd like to discuss in our time together. Select all that apply. * Required

Anxiety and/or stress

Depression

Career & Workplace

Family/Relationships

Intimate/Romantic Relationships

Identity

Grief/loss

Bullying

Domestic Abuse

Sexuality

Disordered Eating

Trauma

General Wellness

Other

What are the goals you hope to accomplish in therapy?

Would you like to schedule a free 15-minute consultation to discuss your options more? *

Yes, please contact me to schedule a free consultation

No thank you, I'm ready to get started.

Thank you! We will be in touch shortly.

Payment Information

Insurance

Aetna

Aetna GEHA

Aetna Meritain

Anthem BCBS Missouri

Cigna

Cigna TPA

Cigna EAP
Home State Health

Medica

Optum

Oscar Health Plan

United All Savers

United Healthcare MO

United Healthcare Golden Rule

Rates may vary by insurance.

Cash Pay

Individual

30 minute - $50

60 minute - $80

Couples

30 minute - $75

60 minute - $100

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