Name *

First Name

Last Name

Phone

(###)

###

####

What services are you interested in? *

Treatment for OCD and Anxiety-related Disorders

Treatment for Hoarding Disorder

Eating Disorder Stabilization (ages 12+)

Acknowledgement of Services *

I understand that this provider exclusively offers the services stated above and detailed on the "Services" page.

I understand

Financial Acknowledgement *

I understand that OtherKind Health is only in-network with the insurance plans listed on the "Finances" page, and that I will be required to pay out of pocket if my plan is not accepted.

I understand