Reese Kelly Counseling | SimplePractice

Reese Kelly Counseling Send Message

Your info

First name

Last name

Phone

Name you go by

Date of birth

Reason for care

What is the reason for seeking care?

Anxiety ADHD Cultural Stress Grief Life Transition OCD Phobia(s) Relationship Issues Trauma Something Else

Billing & Payment

Insurance - Select all that apply

BCBS/CBA Blue Cigna/Evernorth Green Mountain Care/Medicaid MVP No Insurance/Private Pay

Client Preferences

Preferred appointment times

Morning (8-11am) Mid-day (11am-2pm) Afternoon (2-5pm Evening (5-7pm, Tuesday Only)

Day preference

Mon-Wed in-person only. Friday telehealth is now full. Check all that apply

Monday (in-person) - no openings/waitlist Tuesday (in-person) - no openings/waitlist Wednesday (in-person) - no openings/waitlist Friday (telehealth) - no openings/waitlist

Is there anything that the practitioner needs to know?

Administrative

There is currently a waitlist for Reese Kelly Counseling. Please indicate below whether you'd like to be contacted when there is an opening.

YES - Contact me when there's an opening NO - Do not add me to your waitlist.

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.