Name *

First Name

Last Name

Phone *

(###)

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Client Name *

Enter N/A if you are the client

First Name

Last Name

I am interested in: *

Check all that apply.

Individual

Group

Parent Coaching

Professional Consultation

Psychedelic Preparation/Integration

Other

What is your preferred method for therapy? Check all that apply. *

Online

In Person in Austin

Unsure/No preference

Please indicate your scheduling preferences. Select all that apply. *

Amanda is available to meet with clients on Mondays through Thursdays.

Monday

Tuesday

Wednesday

Thursday

Morning (Before 12 PM CST)

Afternoon (12 PM-4 PM CST

Evening (5-6 PM CST)

I would like to work on these areas: *

These are simply estimates that help to know when determining if we are a good fit and you are under no obligation to discuss any of them unless you want to.

Anxiety

Body Shame, Body Image, and Body Liberation

Child/Adolescent Development and Parenting

Depression

Eating Disorders and Disordered Eating

Gender Identity

Grief and Loss

Identity Exploration and Development

LGBTQ+ Issues

Life Transitions

PTSD and Trauma

Racial Identity

Sex and Sexuality

Shame Resilience and Self-Compassion

Stress

Substance Use

Other

How do you plan to pay for services provided? Select all that apply. *

Slow 'n Steady Wellness is considered an out-of-network provider and does not accept insurance at this time. A superbill may be provided upon request for reimbursement from your health insurance plan. Please contact your plan provider to inquire about out-of-network benefits.

Private pay/out-of-pocket

Private pay/reimbursement for out-of-network benefits

I need a reduced fee