New Client Form (Join Waitlist)Your journey matters, and we're honored to walk it with you. To help us understand your needs better, we invite you to fill out our new client form. Each detail you share will help us support you. Is the client a minor (under 18 years old)? * Yes, new client is under 18 No, new client is over 18 Client Email Address * Phone Number * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Presenting Concern(s) * Best Availability * Monday Tuesday Wednesday Thursday Friday Saturday Mornings Afternoons Evenings Exclusively Telehealth * I understand all sessions will be held online Insurance * Atena CareFirst BlueCross BlueShield Anthem EAP - Bank of America Kaiser Permanente of the Mid Atlantic Quest Behavioral Health Carelon Behavioral Health Independence Blue Cross Pennsylvania If you have a different insurance provider, please specify below. Member ID Number * Birthdate * MM DD YYYY Referred by Message You’ve been successfully added to Sharlita Boyd’s waitlist. We’ll notify you when an opening becomes available. Thank you for your patience—and for taking this meaningful step toward care and connection.
