Contact Me for therapy in San Rafael, CA

1. First Name*

2. Last Name*

Please note: All of my Beacon/Partnership Health Plan slots are full. You are welcome to email me at mt@maysietifttherapy.com if you want to be added to my Partnership waitlist, but unfortunately I can't predict how soon an opening will be available.

3. Choose your health insurance plan below (Note: I am only in-network with Partnership Health Plan).*

4. E-mail Address*

5. Phone Number*

Area CodePhone Number

6. Are you covered by a secondary health insurance plan?*

yesnoI dont know

7. Were you referred by your employer's EAP program?*

8. Your state of residence (choose one):*

9. Do you prefer video or in-person visits? (if you're ok with either, please check all that apply)*

VideoIn person - San Rafael officeIn a park (this option may be available during COVID surges)

10. What is your COVID-19 vaccination status? (optional)*

Why do I ask? This may be relevant to decisions about whether or not we can safely meet in person.

11. How did you find me? (include Google search terms used if you remember - thanks!)*

12. Any comments or basic logistical questions you have? (optional)...