Request an Appointment with Haley

Hello, and thanks for reaching out to inquire about starting therapy with me. My availability is Monday-Friday and typically I schedule appointments from 8-5 Monday-Thursday and 8-3 on Fridays.

Before we schedule, please provide the following information so I can see if we can work together. I will email, text, or call you my earliest available appointment.

Haley Dueitt LPC
Name

First NameLast Name
Age
Phone Number
Email
example@example.com
Preferred Method of Contact

EmailTextCall
Reasons for Seeking Therapy
Do you have a preference for Day of Week and Time of Day, or would you like my first available appointment?
How frequently do you prefer to meet?

WeeklyEvery 2-3 WeeksMonthlyEvery 6-8 WeeksQuarterly
I prefer to meet:

In Person: TuscaloosaTelehealth
Our rates are $150/Assessment and $130/55 minute session. Please select your preferred method of payment.

Plan to Utilize InsurancePrivate Pay
If you plan to utilize insurance, what kind of insurance do you have?
If you plan to use insurance, what kind of insurance do you have?

Blue Cross Blue ShieldLucetUprise HealthBHSVIVA HealthPrivate Pay
Do you have any questions for me before we schedule?
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