Ridgeline Therapy | SimplePractice

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First name

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Administrative

Message / Inquiry

Please provide a brief description of your reason for contact

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Are you currently residing in the state of Arizona?

Ridgeline Therapy cannot provide counseling services to individuals who are not physically located in the state of Arizona at the time of their session.

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Are you seeking any paperwork for disability, FMLA, or emotional support animals? *please note all of these things are outside my scope of practice and cannot be ethically provided*

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How did you hear about Ridgeline Therapy?

(Insurance, Psych Today, Referral, Social Media, Google, etc)

Best way and time to reach you

Billing & Payment

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How do you intend to pay for therapy?

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.