Your Name *

First Name

Last Name

Your Phone

(###)

###

####

I am seeking *

Testing / Psych Eval

Therapy (brief solution focused)

Location preference for evaluation

In person (New Albany, Indiana)

Remote (Patient must be in Indiana)

Hybrid (One in person visit with remote intake and other)

If Testing: Who is the testing for?

Myself (ages 18+)

My Child (ages 3-17)

My child (ages 18+) This person will need to contact us directly.

SUMMER 2025 *

By checking this box, I understand that no patient-provider relationship exists until I am seen by a psychologist for the intake session. By checking this box, I understand that psychological testing is intended to fill a gap for needed psychological evaluations, and it is not intended to provide the follow up treatment, such as ABA therapy, Occupational Therapy, IEP services, or medication management. By checking this box, I understand that the therapy offered through Summer 2025 is intended to be a brief, solution-focused modality, and if further treatment is needed, I might be referred to a different therapist.

I agree

Out of Pocket and Insurance *

By clicking this box, I am indicating that I understand the provider is In Network with BCBS, Aetna, and Tricare, and if I carry commercial BCBS, Aetna, or Tricare, I can utilize my insurance benefits for evaluation or treatment. Limited medicaid panels are also accepted but all require prior authorization. If I choose to pay for the evaluation directly, I understand that the fee is $175/hour for an out of pocket evaluation. The typical out of pocket cost ranges from $1,300 to $2,800 depending on the complexity of the case.

I agree

I have read the FAQs page. *

Yes