First Name *

Last Name

Phone

Email *

Preferred Method of Contact

When are you available for therapy? *

What would you like support with? *

Are you looking for virtual or in-person therapy? *

Which type of service are you interested in?

Do you have a therapist gender preference? If so, specify below.

What insurance(s) do you have? *

Who would you like to consult/meet with? *

If your requested therapist isn’t available, would you be open to us matching you with another therapist based on your availability, preferences (virtual or in-person), and what you’re looking for support with? If so, that therapist will personally reach out to you. (copy)

How did you find us?

By checking this box, I consent to receive SMS messages from Therapy on Fig related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out at any time. Whether you have entered your phone number above or not, you must still check this box and accept these terms.