Get Started!

Please submit this form and our Practice Manager will connect you with a therapist who best fits your needs. Some of our providers are in-network with insurance for individual counseling, while all couples and family sessions are private pay. We currently accept Aetna, Blue Cross Blue Shield, and United Healthcare/Optum. Clients remain financially responsible for services if insurance denies coverage. If your therapist is out-of-network, we may provide a superbill—a formal receipt you can submit for possible reimbursement, depending on your plan. Private pay options include cash, check, credit/debit cards, HSA cards, and Zelle. Grant funding for eligible first responders is also available. For more information, please contact us at inquiry@dkccs.com.

Insurance & Payment

Interested in booking an appointment? Please complete the form below and we will be in touch shortly!

First Name

Last Name

Phone

(###)

###

####

How did you hear about us?

What type of services are you interested in?

Individual therapy for a child (age 6-11)

Individual therapy for a teen (age 12-17)

Individual therapy for an adult

Couples therapy (private pay only)

Family therapy (private pay only)

Life coaching (private pay only)

Clinical supervision (private pay only)

Sliding fee scale individual or couples counseling (private pay only)

Preferred Start Date

YYYY

Please briefly describe what you would like to work on

Please share your desired availability for session times

Please select your preference for in-person or virtual sessions

Insurance/Payment Verification

Insured's name and date of birth (if seeking to utilize insurance)

Please list dependent's name and date of birth as well if applicable.

Member ID

Group ID