Consultation Request Consultation Request Request a consultation call with Fostering Greatness – Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Which service are you reaching out about? *Traditional Talk TherapyKetamine-Assisted Therapy (KAP/EAP)I am reaching out about something else (You can continue below, or contact us via our general contact form on our website under “Contact”)Your Name *FirstLastYour Email *How old are you? *Briefly, what are you looking to start therapy to address? *At Fostering Greatness sessions (other than Ketamine therapy sessions in Cherry Hill, NJ) are virtual. Are you open to meeting for therapy sessions virtually (via a secure telehealth video platform)? *YesNoAre you comfortable paying out of pocket for sessions? Our practice is out of network with insurance, but we can provide a monthly superbill should you choose to use your out of network benefits. A superbill is essentially a receipt that you submit to your insurance company for them to reimburse you. This superbill can also be submitted to HSA/FSA accounts, should you choose. *YesNoEven when sessions are virtual, due to licensure laws you must be physically located within the state of New Jersey, Delaware, OR Pennsylvania throughout the duration of your therapy session. Do you understand this & agree to do so? *YesNoIf you answered "No" to any of the past 5 questions and you still wish to submit this contact form please explain your 'no' answer(s) here: *How did you hear about Fostering Greatness? * you? with please Before you submit, do you have any questions for us either about this form or for your consultation? *If you don't hear back about your submission within 1-2 business days (Monday-Thursday) please email the practice directly to follow up in case your submission got lost somewhere in the internet abyss. *You got it, noted! I will email admin@fosteringgreatness.com if I do not hear back within 2 business daysSubmit
