Newton Psychotherapy & Consulting, PLLC

Newton Psychotherapy & Consulting, PLLC Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

State

Select the state you live in

Reason for care

What issues / challenges are leading you to seek support?

Sexual Dysfunction / Libido Challenges Sexual Compulsion / Sex Addiction LGBTQIA+ Support Kink/Diverse Sexualities Open Relationships/Polyamory Other Sex Therapy Religious Harm Recovery Anxiety Depression Grief Relationship Challenges (Not accepting new couples clients) Trauma Other

Administrative

Inquiry reason

Referral source

Enter how you were referred to our services

Client Preferences

Preferred ongoing appointment times (select all that apply)

Bernie's appointment start times are between 10:00am & 4:00pm, Monday - Thursday

First Half of Day (10am - 1pm) Second Half of Day (1pm - 5pm)

Preferred meeting location

Is there anything else that you'd like Bernie to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

Limited to 600 characters

Would you like Bernie to reach out to you for a free 15m phone consult? If so, what time(s) below would work?

(YOU CAN ALSO SCHEDULE A REDUCED-FEE 45m CONSULT ONLINE AT WWW.NEWTONPSYCH.COM)

Monday, 9:00 hour Tuesday, 9:00 hour Wednesday, 9:00 hour Thursday, 9:00 hour Monday, 3:00 hour Tuesday, 3:00 hour Wednesday, 3:00 hour Thursday, 3:00 hour

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.